Chronic Care Management (CCM): 2026 Updates, Billing, and Best Practices
Chronic conditions account for 90% of the $4.5 trillion annual U.S. healthcare expenditure, according to CDC data. Poorly managed chronic illnesses lead to avoidable hospitalizations, emergency visits, and complications, driving up costs and reducing quality of life. CCM programs aim to reverse these trends by improving care coordination and patient engagement.
What is Chronic Care Management?
CCM refers to non-face-to-face services provided to Medicare beneficiaries with two or more chronic conditions expected to last at least 12 months or until death, placing the patient at significant risk of death, acute exacerbation, or functional decline. Complex care management accounts for significant changes in the care plan and requires moderate or high complexity medical decision making. Primary care Management Services are for patients with one or more chronic conditions but focus on a single high-risk condition that is expected to last at least 3 months.
CCM includes:
- Comprehensive care plan creation and monitoring
- Medication reconciliation and management
- 24/7 access to care coordination
- Transition management between care settings and home and community-based care coordination
- Enhanced communications: such as asynchronous secure messaging, chatting, or communication through a mobile app
CMS Rules and Compliance Requirements
To bill CCM services, providers must meet these CMS requirements:
- Patient Consent: Document verbal or written consent.
- Initiating Visit: Required for new patients or those not seen in the past 12 months.
- Certified EHR Use: Maintain an electronic care plan.
- Time Tracking: Time spent caring for patient
- Single Billing Practitioner: Only one clinician can bill CCM per patient per month.
2026 CCM Billing Codes and Reimbursement Rates
| CPT Code | Description | 2026 Reimbursement |
| 99490 | CCM services, ≥20 min clinical staff time | $66 |
| 99491 | CCM services, ≥30 min by physician/qualified professional | $89 |
| 99439 | CCM Services, add-on, each additional 20 min clinical staff time | $50 |
| 99437 | CCM Services, add-on, each additional 30 minutes by physician/qualified professional | $63 |
| 99487 | Complex CCM, ≥60 min clinical staff time | $144 |
| 99489 | Complex CCM, Add-on 30 minutes of clinical staff time | $78 |
| 99424 | PCM, first 30 minutes provided personally by a physician or other qualified health care professional | $88 |
| 99425 | PCM, add-on 30 minutes provided by a physician or other qualified health care professional, per calendar month. | $68 |
| 99426 | PCM, ≥30 min clinical staff time | $68 |
| 99427 | PCM, add-on, each additional 30 min clinical staff time | $54 |
Note: Rates reflect national averages; geographic adjustments apply.
Clinical Best Practices
- Risk Stratification
Beyond identifying high-risk patients, rising-risk patients—those whose conditions are worsening but not yet severe—should be prioritized for CCM. Early intervention prevents costly complications and improves long-term outcomes.
- Comprehensive Care Plans
After a comprehensive assessment, care plans should include:
- Problem list, measurable goals, prognosis, interventions
- Cognitive and functional assessments, environmental evaluation, caregiver assessment
- Medical management including medication adherence strategies
- Social Determinants of Health (SDOH): Address barriers like transportation, food insecurity, and housing that impact care compliance.
- Periodic review
How Sophie Can Help
Sophie, your virtual care assistant, can:
- Educate patients about CCM benefits
- Obtain consent efficiently
- Guide patients through enrollment and answer questions
- Automate care plan review
- Deliver care plan to the patient with reminders of goals and patient tasks
This reduces administrative burden and accelerates program adoption.
Key 2026 Changes
- Reimbursement Increase: 3.26% for non-APM providers; 3.77% for APM participants.
- Telehealth Flexibility: Continued coverage for CCM via telehealth through 2026.
Beyond CCM: Add RPM, BHI and more
CCM is powerful, but it doesn’t have to stand alone. Remote Patient Monitoring (RPM) complements CCM by providing real-time data on vitals and trends, enabling proactive interventions. BHI describes psychiatric care management services for behavioral health conditions. All care management programs require care planning. Ater visits that require extensive face-to-face assessment and care planning by the billing provider, billing is available for that time and effort.
Adding to your CCM program portfolio amplifies patient engagement and outcomes.
Make CCM Easier with BettrAi
While this post helps your organization understand CCM coding and reimbursement, implementing a solution like BettrAi can make these processes seamless. BettrAi simplifies chronic care management by automating workflows, ensuring compliance, and supporting accurate coding—all while fitting effortlessly into your existing operations.
Why BettrAi?
- Streamlines patient enrollment and consent
- Automates care plan delivery and reminders
- Tracks time from start to end of care
- Provides real-time reporting for compliance and billing
- Enhances patient engagement through education and communication tools