Medicare Chronic Care Management: What It Is, Who Qualifies and What You Pay

Medicare pays for chronic care management only if you have at least two chronic conditions expected to last 12 months or more, and you agree to it first. It's billed every month, usually for work you never see: a nurse calling about your blood sugar readings, the office sorting out a medication conflict between two specialists, someone following up after an ER visit. And because it's a Part B service, you pay 20% of the Medicare-approved amount after the Part B deductible, every month it's billed.

That last part can surprise you. A Medicare Summary Notice can show a CCM charge for a month you didn't set foot in the office. That alone doesn't make it a mistake. Here's what chronic care management (CCM) actually includes, how the monthly billing works, what it costs you, and how to stop it if it isn't worth the coinsurance to you.

Source: Medicare.gov, Chronic care management services; CMS MLN909188, Chronic Care Management Services; CMS, 2026 Medicare Parts A and B premiums and deductibles. As of Nov. 13, 2026, CMS hasn't released the 2027 Part B deductible.

Who qualifies

CMS's billing booklet for providers (MLN909188) defines the patient this way: two or more chronic conditions "expected to last at least 12 months, or until their death," that place you "at significant risk of death, acute exacerbation or decompensation, or functional decline." Medicare.gov says the same thing in plainer words: 2 or more serious chronic conditions, like arthritis and diabetes, that you expect to last at least a year.

CMS lists examples, and it says the list isn't complete: Alzheimer's disease and related dementia, arthritis, asthma, atrial fibrillation, autism spectrum disorders, cancer, cardiovascular disease, COPD, depression, diabetes, glaucoma, HIV and AIDS, high blood pressure, and substance use disorders. Two conditions from the list, such as high blood pressure and diabetes, meet the count.

There's also a starting requirement. If you're a new patient, or your provider hasn't seen you in the past year, CMS requires an "initiating visit" first: a face-to-face office visit, an annual wellness visit or a Welcome to Medicare visit where CCM is discussed. That visit is billed separately. If you have your annual wellness visit coming up, it's a natural time for the conversation.

Who can bill it: physicians, nurse practitioners, physician assistants, clinical nurse specialists and certified nurse-midwives. Primary care practices bill most of it, though some specialists do too. Much of the actual work is done by the practice's clinical staff, such as nurses and medical assistants, under the practitioner's direction.

What you get each month

CCM isn't one appointment. It's a set of services the practice commits to providing while you're enrolled. Most of it happens between visits, by phone, portal message or behind the scenes with your other doctors.

Source: Medicare.gov, Chronic care management services; CMS MLN909188, pages 6 to 8.

My honest read: the value depends almost entirely on the practice. A good CCM program means someone notices that your cardiologist and your endocrinologist both changed your prescriptions in the same week. A weak one is a monthly check-in call that you could take or leave. Ask the office what, specifically, they'll do for you, and who you call at 9 p.m. on a Saturday.

Because so much of CCM happens by phone and portal, it overlaps with what people think of as telehealth. It's a separate benefit, though, with its own rules; our post on Medicare telehealth coverage covers the video and phone visit side.

How it's billed: the monthly codes

CCM is billed per calendar month based on time. The codes differ by who does the work (clinical staff or the practitioner personally) and how complex your care is that month. You'll see these numbers on your Medicare Summary Notice or an itemized bill:

Source: CMS MLN909188, Table 2; CMS, Frequently Asked Questions About Practitioner Billing for CCM. CPT codes and descriptions are copyright American Medical Association. Complex CCM also requires moderate or high complexity medical decision-making.

In the table, "practitioner" means a physician or other qualified health care professional; clinical staff codes are billed by the practitioner who directs that staff. Two things follow from the table. First, an add-on code means a second line item, and each line has its own 20% coinsurance. A busy month (say, after a hospital stay) can cost you more than a quiet one. Second, the practice can't mix the basic and complex versions in the same month, and the minutes counted toward CCM can't be counted toward any other billed service. If a month's bill looks doubled up, those are fair questions to ask the billing office.

99490: first 20 min, clinical staff607,24699439: each extra 20 min197,06299487: complex, first 60 min55,34899491: first 30 min, practitioner30,080

Source: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024 data. Counts services, not people. Medicare Advantage claims aren't included.

Show the numbers

Code	Services
99490: first 20 min, clinical staff	607,246
99439: each extra 20 min	197,062
99487: complex, first 60 min	55,348
99491: first 30 min, practitioner	30,080

CCM is not some rare benefit in Florida. In 2024, Florida providers billed 607,246 units of the basic 20-minute code to Original Medicare, according to CMS's provider data. In office settings alone, 2,477 Florida providers billed it for 119,100 people with Medicare. Those figures leave out everyone in a Medicare Advantage plan.

What it costs you

Under Original Medicare, CCM is treated like any other Part B doctor service. Medicare.gov: "After the Part B deductible, you pay 20% of the Medicare-approved amount." It is not a preventive service, so the 100% coverage that applies to the preventive services list doesn't extend to it.

The 2026 Part B deductible is $283. CMS announced the 2026 Part B premium and deductible on November 14, 2025. As of today, the 2027 amounts haven't been posted, so I'm not going to guess at them. When they come out, the math below works the same way with the new deductible.

What the Medicare-approved amount is for your CCM depends on the code, where in Florida the practice is, and whether it's billed from an office or a facility. Medicare.gov also lists your other insurance and whether your doctor accepts assignment as factors. Ask the office for its approved amount before you sign up.

Source: Medicare.gov, Chronic care management services; CMS, 2026 Part B deductible; Medicare.gov, Medicare Savings Programs. The $60 figure is a round hypothetical for illustration, not a CMS payment rate.

Example (hypothetical): Say your practice's Medicare-approved amount for a month of basic CCM is $60. If you've already met the $283 deductible through other doctor visits, you pay $12 a month, or $144 for a full year. If CCM were somehow your only Part B service all year, the first four months ($240) would go to the deductible, month five would use up the remaining $43 and you'd owe $3.40 in coinsurance on the rest, and then $12 a month after that.

So the question to ask yourself is simple: is what the practice does for you each month worth that coinsurance? For someone juggling diabetes, heart failure and six prescriptions, probably. For someone whose two conditions are stable and well controlled, maybe not. Either answer is fine; it's your choice.

Consent, and how to stop

No practice can bill CCM without your consent first. It can be written or verbal; Medicare.gov describes your provider asking you to sign an agreement, and CMS has allowed verbal consent since 2017. Before you agree, CMS requires the practice to tell you four things and note them in your record:

1. That CCM is available to you.
2. That you may owe cost sharing for it.
3. That only one practitioner can provide and bill CCM in a calendar month.
4. That you can stop at any time, effective at the end of the calendar month.

You consent once. You don't re-sign every year, so it's easy to forget you agreed. A new consent is needed only if you switch to a different practitioner for CCM.

If you never agreed and you're seeing CCM charges, CMS's FAQ is direct: if the patient didn't consent, or other conditions weren't met, the practitioner "cannot bill Medicare or the beneficiary for CCM." Call the billing office and ask to see the consent in your record. If it's not resolved, call 1-800-MEDICARE.

The one-practitioner rule matters if you see several doctors. If your primary care office and a specialist both want to enroll you, only one gets to bill CCM for a given month. Pick the office that actually coordinates your care.

PCM, APCM and other care management

CCM has relatives, and your bill may show one of them instead.

Principal care management (PCM) is for one serious, high-risk condition expected to last at least 3 months. It's billed monthly too (codes 99424 through 99427), with at least 30 minutes per month. A primary care doctor can bill CCM and a specialist can bill PCM for you in the same month, as long as they're managing different conditions; the same practitioner can't bill both.

Advanced Primary Care Management (APCM) started January 1, 2025, under the CY 2025 Physician Fee Schedule final rule. It bundles chronic care management, principal care management, transitional care and some communication services into one monthly charge with no minute counting. Your primary care provider agrees to be your main point of care. CMS uses three levels: one for people with one or fewer chronic conditions, one for two or more, and one for people with two or more who also have Qualified Medicare Beneficiary (QMB) status. Since January 1, 2026, practices can add optional behavioral health integration codes in the same month.

The cost rules are familiar: per Medicare.gov, you pay 20% of the Medicare-approved amount after the Part B deductible, you give verbal or written consent, and you can stop at any time. Only one provider can bill APCM for you in a month.

Source: CMS MLN909188, pages 11 and 12; CMS CCM FAQs; CMS, Advanced Primary Care Management Services; Medicare.gov, Advanced Primary Care Management services.

You may also run into transitional care management, which covers the 30 days after you're discharged from a hospital, skilled nursing facility or rehab facility. CCM can continue during that window. CCM can't be billed in the same period as Medicare's home health or hospice care supervision codes, though.

What changes in 2027

CMS released the CY 2027 Physician Fee Schedule final rule on November 4, 2026, effective for services on or after January 1, 2027. The fact sheet opens its chronic-illness section by noting that three in four American adults have at least one chronic condition and more than half have two or more.

The fact sheet doesn't list any changes to the CCM codes or to APCM. What it does finalize for chronic conditions is new: separate coding and payment for shared medical appointments, where a group of patients with similar health challenges gets clinical guidance together, plus changes to how some behavioral health and advance care planning services are coded and paid. Most of the rule is about provider payment, which doesn't change your 20% share of whatever the approved amount is. I'll update this post if CMS publishes CCM-specific changes, and once the 2027 Part B deductible is out.

Medigap, Medicaid, Medicare Advantage and SHINE

Medigap. CMS's booklet notes that some patients have Medigap "to help cover CCM cost sharing," and its FAQ says that when a service is covered under Part B, a Medigap insurer can't deny the coinsurance its policy pays. How much your policy picks up depends on its plan letter. Per Medicare.gov's Medigap comparison chart, Plans K and L pay 50% and 75% of Part B coinsurance, Plan N pays the Part B coinsurance but can charge office-visit copayments of up to $20, and only Plans C and F cover the Part B deductible. Not everyone can buy C or F; it depends on when you first became eligible for Medicare. Our Florida Medicare Supplement page explains how the letters differ.

Medicaid and the Medicare Savings Programs. If you're a Qualified Medicare Beneficiary, Florida Medicaid pays your Medicare premiums, deductibles and coinsurance under the DCF program rules, and Medicare.gov says providers aren't allowed to bill QMB members for Medicare-covered services, including deductibles and coinsurance. CMS's CCM FAQ says the same about CCM specifically. If money is tight, check our guides to the Medicare Savings Program in Florida and Florida Medicaid and Medicare.

Medicare Advantage. A Medicare Advantage plan has to cover everything Part B covers (42 CFR 422.101), but your cost share follows the plan's own rules and network. Medicare.gov's wording on APCM applies here too: if you have a Medicare Advantage plan, your costs might be different, so contact your plan. Check your Evidence of Coverage before you consent.

Unbiased help in Florida. SHINE (Serving Health Insurance Needs of Elders), run by the Florida Department of Elder Affairs and the local Area Agencies on Aging, gives free, unbiased, confidential Medicare counseling. Call 1-800-963-5337 (TTY 1-800-955-8770) or use the online request form. A SHINE counselor can help you read a Medicare Summary Notice line by line. Our SHINE guide explains how to get an appointment, and our Florida Medicare page covers how the pieces of Medicare fit together.

FAQ

Does Medicare pay for chronic care management?

Yes. Part B covers chronic care management monthly if you have two or more chronic conditions expected to last at least 12 months and you give your provider written or verbal consent. Under Original Medicare you pay 20% of the Medicare-approved amount after the Part B deductible.

Why am I getting a monthly bill for chronic care management when I didn't see my doctor?

CCM is billed for work done between visits, such as care coordination, medication review and phone follow-up, as long as the practice spent at least the required time that month. If you never consented, the practice can't bill Medicare or you for it; ask the billing office to show you the consent.

Can I stop chronic care management?

Yes. You can stop at any time; per CMS it takes effect at the end of the calendar month. Tell your provider's office.

Can two doctors bill chronic care management in the same month?

No. Only one practitioner can provide and bill CCM for you in a calendar month. A specialist can bill principal care management for a different condition in the same month.

Does Medigap cover chronic care management coinsurance?

CMS says that when a service is covered under Part B, a Medigap insurer can't deny the coinsurance its policy pays. How much is covered depends on your plan letter: Plans K and L pay 50% and 75% of Part B coinsurance, and only Plans C and F cover the Part B deductible.

Federal Medicare rules and your own plan or policy documents control what's covered and what you pay. Confirm your situation with Medicare, SHINE or a licensed agent before you agree to monthly services.

Sources

1. Medicare.gov: Chronic care management services
2. Medicare.gov: Advanced Primary Care Management services
3. Medicare.gov: Medicare Savings Programs
4. Medicare.gov: What Medigap covers
5. Medicare.gov: Compare Medigap plan benefits
6. CMS MLN909188: Chronic Care Management Services (June 2025)
7. CMS: Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services
8. CMS: Advanced Primary Care Management Services
9. CMS: CY 2025 Medicare Physician Fee Schedule final rule fact sheet
10. CMS: CY 2027 Medicare Physician Fee Schedule final rule fact sheet (Nov. 4, 2026)
11. CMS: 2026 Medicare Parts A and B premiums and deductibles
12. CMS: Medicare Physician & Other Practitioners by Geography and Service (2024 data)
13. eCFR: 42 CFR 422.101, Requirements relating to basic benefits
14. Florida DCF: ESS Policy Manual, chapter 2000 (Medicare Savings Programs)
15. SHINE (Florida Department of Elder Affairs)
16. SHINE: Contact Us