Yes, Medicare Part B covers chronic care management (CCM) if you have two or more chronic conditions expected to last at least 12 months, or until death, and that put you at meaningful risk of hospitalization, decline, or death. CCM is a real, billable Medicare benefit built around monthly phone or video check-ins with a nurse or care coordinator who manages your medications, coordinates between your doctors, and keeps your care plan on track between office visits. Medicare pays the bulk of the cost, and you typically owe a small monthly coinsurance of around $7 to $13, unless you have supplemental coverage that picks up the rest.
If you're managing diabetes, high blood pressure, heart disease, COPD, or another ongoing condition, CCM is one of the most underused benefits in traditional Medicare. Most eligible beneficiaries have never been offered it, largely because it requires a doctor's office to actively enroll patients and bill for the service every month. This guide explains exactly what CCM covers, what it costs in 2026, and how to get enrolled, including a free option that does the legwork for you.
What Is Chronic Care Management (CCM)?
Chronic care management is a Medicare Part B service where clinical staff, working under a physician's supervision, spend at least 20 minutes per month outside of your regular appointments managing your chronic conditions. That time typically covers:
- Reviewing and reconciling your medications
- Coordinating between specialists, your primary care doctor, and pharmacies
- Updating a written care plan you can access anytime
- Checking in on symptoms, refills, and any recent hospital or ER visits
- Helping you understand test results and next steps
It's not a replacement for your regular doctor visits. It's ongoing support between them, delivered mostly by phone.
Medicare CCM Billing Codes, Explained
CCM is billed under specific CPT codes, and Medicare's 2026 physician fee schedule sets the reimbursement rate for each one. You won't need to memorize these, but it helps to know what your provider is billing for, since it affects your monthly coinsurance.
| CPT Code | What It Covers | Approx. 2026 Medicare Payment (non-facility) |
|---|
| 99490 | First 20 minutes of non-complex CCM per month | $66.13 |
| 99439 | Each additional 20 minutes (up to 2x/month) | $50.44 |
| 99487 | First 60 minutes of complex CCM per month | $144.29 |
| 99489 | Each additional 30 minutes of complex CCM | Add-on rate, billed with 99487 |
| 99491 / 99437 | CCM performed personally by the physician (not staff) | Billed separately from staff-directed codes |
| G0511 | CCM furnished at a Rural Health Clinic or FQHC | Facility-specific bundled rate |
Only one provider can bill CCM for you in a given month, and non-complex and complex CCM codes can't be billed together for the same month. If your care team bills 99490, that's what you'll see reflected in your Medicare Summary Notice, along with your 20% share.
Who Qualifies for Medicare CCM in 2026
To be eligible, you need to meet all of the following:
- You're enrolled in Original Medicare (Part B) or a Medicare Advantage plan that covers CCM (most do, since it's a covered Part B service).
- You have two or more chronic conditions expected to last at least 12 months or until death. Common qualifying conditions include diabetes, hypertension, heart failure, COPD, arthritis, depression, chronic kidney disease, and Alzheimer's disease.
- Those conditions place you at significant risk of death, acute exacerbation, decompensation, or functional decline.
- You've had a visit with the billing provider within the past year (an annual wellness visit, initiating visit, or recent office visit typically satisfies this).
- You give consent, verbal or written, to enroll in CCM with a specific provider. This is a one-time step unless you switch which provider bills for your CCM.
If you check these boxes, in most cases you already qualify, whether or not your doctor's office has mentioned it.
What Does CCM Cost With Medicare in 2026?
CCM is subject to the standard Medicare Part B cost-sharing rules:
| Cost Component | 2026 Amount |
|---|
| Part B annual deductible | $283 (applies once per year across all Part B services) |
| Part B coinsurance on CCM | 20% of the Medicare-approved amount |
| Typical out-of-pocket cost for 99490 | Approximately $13 per month |
| Cost if you have Medicaid or a Qualified Medicare Beneficiary (QMB) status | $0 |
| Cost if you have a Medigap plan covering Part B coinsurance | $0 (Medigap picks up the 20%) |
If you have a Medicare Supplement (Medigap) plan, most plans cover the CCM coinsurance in full, meaning CCM costs you nothing beyond your existing premium. If you have Medicare Advantage, your cost-sharing depends on your specific plan, but many MA plans offer CCM at low or no cost as part of chronic condition management programs.
How to Start Chronic Care Management
- Ask your primary care provider directly. Say: "I have [conditions]. Am I eligible for chronic care management, and do you offer it?" Many practices have a CCM program but don't proactively enroll patients.
- Have an initiating visit if you haven't seen this provider recently. An annual wellness visit or a standard office visit within the past 12 months usually qualifies.
- Give consent. Your provider's staff will explain the monthly coinsurance and confirm you understand only one provider can bill CCM per month.
- Expect a monthly check-in. A nurse or care coordinator will call or video chat with you for at least 20 minutes to review medications, symptoms, and your care plan.
- Watch for it on your Medicare Summary Notice. You'll see the CPT code and your share of the cost listed there each month CCM is billed.
If your doctor's office doesn't offer CCM, or you're not sure who to ask, you don't have to sort this out alone.
A Free Way to Get Chronic Care Management Coordinated For You
Many Medicare beneficiaries with chronic conditions never get connected to CCM simply because no one at their doctor's office initiates the conversation. Benefits USA partners with a free Medicare care advocacy service that helps people managing diabetes, high blood pressure, heart disease, and other chronic conditions get connected with providers who offer chronic care management, understand what it will cost given your specific Medicare coverage, and get consented and enrolled without having to navigate the paperwork yourself.
Take our quick quiz to see if you qualify for a free care advocate who can help set up chronic care management and coordinate the rest of your Medicare-covered care.
Check your eligibility for free Medicare care coordination →
CCM vs. Advanced Primary Care Management (APCM)
Starting in 2026, Medicare also offers Advanced Primary Care Management (APCM), a newer, broader care coordination benefit that some practices are adopting alongside or instead of traditional CCM. APCM bundles care coordination into flat monthly rates based on patient complexity, rather than requiring a minimum number of minutes each month. If your provider mentions APCM instead of CCM, it serves a similar purpose. Ask which one they bill and how it affects your monthly cost.
Frequently Asked Questions
Does Medicare cover chronic care management in 2026?
Yes. Chronic care management is a covered Medicare Part B service for beneficiaries with two or more chronic conditions expected to last at least 12 months. Medicare covers 80% of the approved cost, and you're responsible for the remaining 20% coinsurance unless you have supplemental coverage.
How much does chronic care management cost with Medicare?
For the base CCM code (99490), the 2026 Medicare-approved amount is about $66 per month, meaning your 20% coinsurance is roughly $13 a month. If you have Medigap, Medicaid, or QMB status, your cost is typically $0.
Do I need to ask my doctor for chronic care management, or will they offer it automatically?
In most cases, you need to ask. CCM requires the practice to actively enroll you, obtain consent, and bill monthly, and many offices simply haven't set this up even when patients qualify. Ask your provider directly if you have two or more chronic conditions.
Can I get chronic care management through Medicare Advantage?
Yes. Medicare Advantage plans are required to cover everything Original Medicare covers, including CCM, though your specific copay or coinsurance depends on your plan. Many Medicare Advantage plans include chronic condition management programs at low or no additional cost.
What conditions qualify for CCM under Medicare?
Any combination of two or more chronic conditions expected to last at least a year or until death, and that place you at risk of decline. Common qualifying conditions include diabetes, hypertension, heart failure, COPD, chronic kidney disease, arthritis, depression, and Alzheimer's disease or other dementias.
Is chronic care management the same as a doctor's appointment?
No. CCM happens between your regular appointments, usually as a phone or video check-in with a nurse or care coordinator. It doesn't replace your in-person visits with your doctor.
Can I stop chronic care management if I no longer want it?
Yes. You can stop CCM services at any time. This is part of the consent you give when you enroll, and your provider is required to honor it.
What is the difference between CCM and Advanced Primary Care Management (APCM)?
Both are Medicare-covered care coordination services for people with chronic conditions. CCM is billed based on minutes of staff time each month, while APCM uses flat monthly rates based on patient complexity. Which one your provider offers depends on how their practice bills Medicare.
Not sure what else you might qualify for beyond chronic care management? Use our free benefits screener to check your eligibility for Medicare Savings Programs, Extra Help with prescription costs, and other assistance in one place.
