The following are approximate national average non-facility reimbursement rates for CCM services effective January 1, 2026, under the CY 2026 Medicare Physician Fee Schedule. Actual reimbursement varies by geographic location based on GPCI adjustments.
Non-Complex CCM (Clinical Staff Time):
CPT Code | Description | 2026 National Average
| 99490 | First 20 minutes of clinical staff time per calendar month | ~$66 |
| 99439 | Each additional 20 minutes of clinical staff time (max 2 units per month with 99490) | ~$50 |
Non-Complex CCM (Physician/QHP Time):
CPT Code | Description | 2026 National Average
| 99491 | First 30 minutes of physician/QHP time per calendar month | ~$89 |
| 99437 | Each additional 30 minutes of physician/QHP time | ~$63 |
Complex CCM:
CPT Code | Description | 2026 National Average
| 99487 | First 60 minutes of clinical staff time, complex CCM | ~$144 |
| 99489 | Each additional 30 minutes of clinical staff time, complex CCM (add-on to 99487) | ~$78 |
Care Plan Oversight:
HCPCS Code | Description | 2026 National Average
| G0506 | Comprehensive assessment and care planning (one-time per patient per provider) | Billed separately; see PFS lookup |
The CY 2026 PFS includes two separate conversion factors for the first time: $33.5675 for qualifying APM participants and $33.4009 for non-qualifying APM participants. Both represent increases from the CY 2025 conversion factor of $32.3465. The increase includes a temporary 2.5% statutory increase provided under the One Big Beautiful Bill Act, small permanent MACRA-required updates, and a positive budget-neutrality adjustment of +0.49%.
Care management codes are time-based and were exempt from the 2.5% efficiency adjustment applied to non-time-based services in CY 2026.
Sources:
CMS CY 2026 PFS Final Rule (CMS-1832-F);
CMS PFS Relative Value Files.
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