Helping patients manage two or more ongoing health issues keeps them safe and out of the hospital. But getting paid for that extra time can be a headache, especially since Medicare changed its payout rates and tightened its audit rules for 2026.
This guide breaks down the 2026 codes in plain English. You will see exactly what each code pays and the exact paperwork your team needs to keep. Whether you are starting a new program or fixing your current setup, this breakdown helps you protect your clinic’s income without the stress of insurance rejections.
It is just a way to get paid for checking on your sickest patients when they are at home. For this to work, a patient has to have two or more long-term sicknesses, like high blood pressure mixed with diabetes, that will last at least a year. The main guideline is that their health has to be bad enough that they could easily wind up in the ER if your team isn’t watching them.
You do not need the patient in the office for this. Medicare pays for the calls and desk work your clinic does between normal appointments.
Your team uses the time to call the patient, update their charts, check their pills, and talk to their other doctors. It also covers helping them book lab tests and catching bad symptoms early before things get dangerous. It keeps patients safe, and it stops your staff from doing all this phone work for free.
Use these six Medicare codes to bill for monthly care tracking based on staff time, provider involvement, and case complexity.
| CPT Code | What It Covers | Minimum Time Per Month | Who Performs the Work? |
| 99490 | Non-complex Chronic Care Management (CCM) | First 20 minutes | Clinical staff under the direction of a physician or other qualified healthcare professional (QHP) |
| 99439 | Add-on code for additional non-complex CCM time | Each additional 20 minutes | Clinical staff under physician/QHP direction |
| 99491 | CCM services personally performed by a physician or QHP | First 30 minutes | Physician or other qualified healthcare professional personally providing care management |
| 99437 | Add-on code for additional physician/QHP CCM time | Each additional 30 minutes | Physician or QHP personally providing CCM |
| 99487 | Complex Chronic Care Management | First 60 minutes | Clinical staff under physician/QHP direction |
| 99489 | Add-on code for additional complex CCM time | Each additional 30 minutes | Clinical staff under physician/QHP direction |
Note: Add-on codes (99439, 99437, 99489) must pair with a primary code and cannot be billed alone.
Medicare will not let you enroll just any patient into this program. To bill for these services, a patient has to check a few specific boxes before your team ever starts tracking their minutes.
The Core Requirements
Your patient must be dealing with at least two health issues. These illnesses need to be long-term, meaning they will last for a full year or until the patient passes away.
The sicknesses have to be severe enough that things could go wrong quickly. We are talking about a high chance of a sudden hospital stay, a bad flare-up, or a serious drop in physical health if your clinic isn't tracking them.
There needs to be a master care plan in place. Your team has to spend time creating, changing, or regularly checking a digital care roadmap built around that specific patient.
Common Conditions You Can Enroll
Most everyday illnesses that you treat will count toward the program. It is very common to sign up patients who have combinations of:
Since the vast majority of older adults on Medicare already have two or more of these illnesses, you likely have plenty of eligible patients sitting in your files right now. Getting them into the program keeps them much safer at home, and it ensures your clinic gets a steady monthly payout for the extra phone calls and desk work you are already doing.
Good charting is the only way to protect your Chronic Care Management revenue. Even if a patient perfectly qualifies for the program, missing notes or incomplete files will trigger immediate claim denials or forced paybacks during a Medicare audit.
To get your claims approved without a fight, your electronic health records must always hold these core pieces:
A simple note proving you explained the program and the patient gave the green light to participate.
A complete, electronic health roadmap that your team looks over and updates whenever the patient's health shifts.
Clear notes on exactly what chronic conditions the patient has and how those problems impact their daily life.
A written record of every phone call, prescription check, and specialist check-in done behind the scenes during the month.
Airtight minute-by-minute tracking showing precisely how long your staff spent working on that patient's care.
Written proof of any time your team talks with family members, local pharmacies, or outside specialists to sync up care.
Generally, these services must be billed by:
Have your staff note down what they did the exact moment they finish the task so details do not get lost.
Never use rounded numbers or rough estimates for your time tracking. Use absolute, precise numbers so auditors can see the real work.
Make sure the time your team clocks for care management never overlaps with other remote monitoring programs.
Open up the master care plan and update the clinical goals the moment a patient undergoes a major medical change.
Solid charting does more than just secure your monthly Medicare payments. It gives your team a clear, audit-proof record that shows exactly how much extra work you do to keep your patients healthy between regular office visits.
Looking at the code numbers is one thing, but figuring out how they actually apply to your daily schedule is what keeps your claims from getting rejected. Here are a few quick, real-world examples showing how you choose a code based on your monthly minutes, who did the work, and how bad the patient’s case is.
The Situation: You have a patient with high blood pressure and diabetes who gets 22 minutes of care tracking over the month. Your clinical staff handles everything behind the scenes by reviewing their medications, calling a specialist to coordinate appointments, and updating the patient's digital care chart.
The Situation: That exact same patient has a rough month and ends up needing 45 minutes of help from your staff. This extra time goes toward making multiple follow-up calls, tracking their daily blood pressure logs, and sorting out a massive pharmacy mix-up.
The Situation: Your actual physician or nurse practitioner personally spends 35 minutes reviewing a patient’s chart, rewriting parts of the treatment plan, and speaking directly with the patient on the phone to explain the updates. No clinical staff time is used here.
The Situation: A patient has severe heart failure and advanced kidney disease. Because their health is highly unstable, your staff spends 65 minutes coordinating their doctors, adjusting complex medication schedules, and tracking sudden weight changes to keep them out of the ER.
The Situation: That same complex heart and kidney patient needs a massive amount of oversight, stretching your team's total monthly time to 95 minutes. This involves constant check-ins with family members, ordering home health adjustments, and syncing closely with a cardiologist.
Getting your Medicare claims approved comes down to three basic details: totaling up your exact minutes for the month, logging who actually did the work, and matching the code to how severe the patient's illnesses are. Accurate tracking means you get paid exactly what you earned without failing an audit.
Billing Chronic Care Management alongside other Medicare programs is fully permitted. However, you must track all staff minutes and clinical charts completely separate to prevent compliance audits or double-dipping claim denials.
Pairing CCM with remote monitoring improves outcomes. Discover how to maximize your clinic revenue safely by integrating these services through MediRemote Chronic Care Management, which simplifies your tracking workflows.
Setting up a solid Chronic Care Management system helps your sickest patients stay healthy while bringing steady, predictable income into your clinic. The secret to making it work is keeping clean medical charts and tracking every minute your staff spends helping patients.
These simple documentation habits will help your office manager fix billing mistakes before they cause denials. Staying compliant ensures your team gets paid for every phone call, pharmacy check, and quick care update they handle between regular office visits.
It is a way for doctors to track patient vitals like blood pressure or weight from home using cellular medical devices that automatically send data straight to the clinic.
Patients use our cellular devices at home. The readings automatically sync to our system, where we review the data and flag issues for your staff.
We handle all background work like shipping home devices, calling missing patients, tracking care minutes, and sorting incoming daily data logs.
No, your practice does not need to hire anyone. Our dedicated clinical team manages the daily operations for you.
We provide full operational management for Remote Patient Monitoring, Chronic Care Management, and Principal Care Management structures.
Our monitoring devices use built-in cellular networks. Patients just turn them on without needing Wi-Fi, smartphone apps, or Bluetooth.
We procure and deliver devices to your practice or facility, where they are distributed to patients. Our support line handles all technical troubleshooting directly.
We deliver complete, structured time-tracking logs and clinical summaries at the end of every month for clean claim submissions.
