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CPT 99490
Description, Billing Rules, and Use Cases

CPT 99490 is the most frequently billed code for Chronic Care Management (CCM) services.

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On this page, you’ll find billing rules, eligibility requirements, compliance tips, and practical examples to help your team apply 99490 correctly and avoid costly mistakes.

What is CPT Code 99490?

CPT 99490 covers the first 20 minutes of clinical staff time each calendar month for providing CCM services. These services must be directed by a physician or other qualified healthcare professional. This code is used to support patients with two or more chronic conditions. 

 

Both conditions must be expected to last at least 12 months or for the duration of the patient's life.

 

​99490 serves as the base code for recurring CCM billing. That means it is considered the foundational, first-priority code when administering CCM services that are not face to face, such as care coordination over the phone, patient portal, or EHR documentation tasks.

 

It must be submitted before any additional time is billed using CPT 99439.

CPT 99490 Billing Requirements and Eligibility

CPT 99490 billing compliance relies on a few key conditions, all of which must be met for reimbursement.

 

This code is used for CCM services administered outside of face-to-face interactions, including EMR data entry, care plan check-ins over the phone, and communication through the patient portal. These services must be provided by clinical staff under the supervision of a physician or other qualified healthcare professional.

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Guarantee compliance and approval of your CPT 99490 billing submissions by adhering to the following rules:

Patient Eligibility Criteria

  • The patient must have two or more chronic conditions which:

    • Are expected to last at least 12 months, or until the patient’s death

    • Place the patient at significant risk of functional decline, acute exacerbation, or hospitalization
       

  • A comprehensive care plan must be:

    • Established, implemented, revised, or monitored during the billing period

    • Documented in the medical record and shared with the patient as appropriate

Provider Requirements

  • CPT 99490 must be billed by a physician, nurse practitioner, or physician assistant who supervises the clinical staff providing CCM services

  • Services must be performed by clinical staff, not the billing provider themselves

Service Requirements

  • The care must include at least 20 minutes of non-face-to-face CCM services per calendar month (e.g., emails through the patient portal)

  • Time must be separate and distinct from any face-to-face services (e.g., office visits)

Billing Documentation Checklist

  • 20+ minutes of clinical staff time spent on non-face-to-face care during the calendar month
    (Include time logs or EHR entries with dates, activities, and totals)

  • A comprehensive, patient-specific care plan that was established, monitored, or revised during the billing period
    (Should address all chronic conditions and be accessible in the chart)

  • Confirmation of patient eligibility and consent, including:

    • At least two qualifying chronic conditions

    • Risk of decline or hospitalization

    • Verbal or written consent to participate in CCM services

CPT 99490 Time Thresholds and Code Combinations

CPT 99490 covers the first 20 minutes of non-face-to-face care management time delivered by clinical staff under the direction of a provider. If more time is spent during the same calendar month, it must be billed using one or more add-on codes — specifically, CPT 99439.

CPT Table 99490.png

When to Use CPT 99490:
Common Scenarios and Use Cases

Need to improve your clean claim rate or avoid denials? These best practices can help:

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  • Track time accurately using EMR-integrated care management tools

  • Standardize documentation workflows with a templated format that includes time spent, staff name, care provided, and patient goals

  • Always bill 99490 first before using 99439 for additional time — never the reverse

  • Reconfirm consent annually and document it in the patient record

  • Ensure patient eligibility: 99490 requires two or more chronic conditions expected to last at least 12 months

  • Monitor billing frequency: 99490 can only be billed once per calendar month per patient, regardless of how much time is provided

Common CPT 99490 Billing Mistakes
(and How to Avoid Them)

  • ❌ Underreporting time: Failing to include all qualifying minutes can result in underbilling.
    Avoid it by documenting all non-face-to-face care activities performed by clinical staff.

  • ❌ Overbilling without documentation: Billing CPT 99490 without proper time tracking, patient consent, or chronic condition documentation risks denial.
    Avoid it by using a documentation checklist and maintaining complete records.

  • ❌ Skipping add-on codes for extra time: If more than 20 minutes of care is provided, CPT 99490 must be paired with add-on code 99439.
    Avoid it by training staff to apply 99439 for each additional 20-minute increment.

  • ❌ Counting provider time instead of clinical staff time: Only time spent by clinical staff counts toward CPT 99490 — not physicians or NPs.
    Avoid it by ensuring time tracking is limited to CMS-qualified clinical personnel.

  • ❌ Missing consent documentation: Submitting 99490 claims without patient consent is a common audit trigger.
    Avoid it by capturing consent before initiating services and reconfirming annually.

  • ❌ Adding modifiers unnecessarily: 99490 typically does not require a modifier.
    Avoid it by only adding modifiers when specifically required by the payer.

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