99490 CPT code is one of the most commonly used billing codes for Chronic Care Management (CCM). It covers 20 minutes of non-face-to-face care coordination services provided to Medicare patients with multiple chronic conditions. For billers and administrators, understanding how to correctly document and submit claims for this code is essential for compliance and reimbursement.
This FAQ guide breaks down the most frequent questions medical billers ask about CPT 99490, helping you navigate requirements with clarity and confidence.
What is CPT Code 99490
CPT code 99490 is defined by the American Medical Association (AMA) as:
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
- Two or more chronic conditions expected to last at least 12 months, or until the patient’s death.
- Conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.
- Comprehensive care plan established, implemented, revised, or monitored.
In practice, this means 99490 is used when clinical staff under physician or provider supervision spend at least 20 minutes per month on non-face-to-face chronic care management activities.
Which Patients Qualify for 99490
To be eligible for 99490 billing:
- The patient must have two or more chronic conditions (e.g., diabetes, hypertension, COPD).
- The conditions must be expected to last at least 12 months or until death.
- The conditions must pose a significant health risk if not properly managed.
- The provider must develop and maintain a comprehensive care plan that is shared with the patient.
Who Can Bill 99490
- Physicians
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Certified nurse midwives (CNMs)
These professionals may bill 99490, but the actual 20 minutes of care coordination can be performed by clinical staff, provided it is under their general supervision.
What Services Count Toward the 20 Minutes
The 20 minutes may include:
- Reviewing test results and lab work
- Coordinating with other providers or specialists
- Adjusting care plans
- Medication management and refills
- Patient or caregiver communication (phone calls, portal messages)
- Updating and monitoring patient goals
Important: The time must be documented clearly in the patient’s record, with a date and description of the activity.
What Documentation Is Required
Billers should ensure providers include:
- Patient consent (verbal or written, documented in the record)
- A comprehensive care plan stored in the patient’s medical record
- Time logs showing at least 20 minutes per month of qualifying activities
- Clinical staff involvement and provider oversight
- Details of non-face-to-face services provided
Proper documentation is key to surviving an audit and securing reimbursement.
Can 99490 Be Billed with Other Codes
- Yes, but with restrictions:
99490 cannot be billed in the same month as other CCM codes that overlap in time, such as 99487 (complex CCM) or 99491 (provider-only CCM).
- Transitional Care Management (TCM) and certain home health codes may also conflict with CCM billing in the same month.
Billers must verify payer rules and ensure no duplication.
How Much Does Medicare Reimburse for 99490?
- The average Medicare reimbursement for 99490 is approximately $62–$65 per month per patient (varies by region and year).
- Payment is made once per calendar month when documentation supports the service.
- Private payers may reimburse at different rates, depending on plan policies and parity laws.
What Are Common Billing Errors with 99490
Some frequent mistakes include:
- Failing to obtain or document patient consent
- Not meeting the 20-minute threshold
- Lack of a care plan or insufficient documentation
- Billing 99490 in the same month as conflicting codes
- Incorrect provider supervision
Avoiding these errors can prevent claim denials and reduce audit risk.
Why Is 99490 Important for Chronic Care Management?
CPT 99490 plays a critical role in value-based care by:
- Improving patient outcomes through consistent follow-up
- Reducing hospital readmissions and ER visits
- Supporting providers financially for time spent outside office visits
- Encouraging better coordination between care teams
Key Takeaways
- 99490 CPT code covers at least 20 minutes of chronic care management per month for Medicare patients with two or more serious chronic conditions.
- Proper documentation, consent, and care planning are essential for compliance.
- Reimbursement is steady but requires strict adherence to Medicare’s rules.
- Billers must monitor code conflicts, maintain audit-ready records, and confirm payer-specific rules.
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Disclaimer: This blog is for informational purposes only and does not constitute legal, financial, or medical advice. Billers and providers should consult the Centers for Medicare & Medicaid Services (CMS), the AMA CPT manual, and payer policies for official guidance before billing CPT code 99490.
