What 99490 is and whether Medicare covers it

CPT code 99490 is a billing code for chronic care management services — a doctor or nurse spending time on the phone, by find message, or in person coordinating care for a patient with two or more chronic conditions. Medicare Part B does cover 99490, but only if your doctor's office meets specific requirements and your conditions meet the definition Medicare uses.

The service itself is not a procedure you go to an office to have done. It is administrative work your doctor's team does to manage your ongoing conditions — things like diabetes, heart disease, arthritis, or COPD. Medicare pays the practice a flat fee per month (usually $42 to $50, depending on your plan) when the code is billed correctly. You do not pay separately for this service if you have Part B.

The catch is that many practices do not bill 99490 because the paperwork requirements are strict, or because they do not have the systems in place to track the time and document it the way Medicare requires. If your doctor's office does bill it, you should see it on your Explanation of Benefits (EOB) as a covered service with no cost to you.

Key Takeaways

  • Code 99490 covers chronic care management work done by your doctor's office, not a procedure you receive, and Medicare Part B covers it with no patient cost.
  • Your doctor's office must have your written permission, a certified electronic health record system, and staff available 24/7 to handle urgent issues before they can bill 99490.
  • You must have at least two chronic conditions that are expected to last at least three months and require ongoing medical attention for Medicare to pay.
  • Many practices do not bill 99490 because the documentation and system requirements are complex, so ask your doctor whether they offer this service.

What conditions may have access to for 99490 billing

Medicare requires that you have at least two chronic conditions that are expected to last three months or longer and need ongoing care. Common examples are diabetes and high blood pressure, heart disease and arthritis, or COPD and kidney disease. The conditions do not have to be severe — they just have to be the kind that need regular monitoring and adjustment.

Your doctor's office decides whether your specific conditions meet this definition. They are not required to offer 99490 to every patient with two chronic illnesses. Some practices set their own thresholds — for example, they might only bill it for patients with three or more conditions, or only for patients they see in person at least once a year.

If you have two or more chronic conditions and your doctor's office has not mentioned 99490, you can ask whether you are a candidate. The office staff can tell you whether your conditions fit their criteria and whether they currently bill for this service.

What your doctor's office must do to bill 99490

Before your doctor's office can bill Medicare for 99490, they must get your written permission. This is usually a separate form you sign that says you agree to let them provide chronic care management services and bill Medicare for the time they spend. You can refuse or withdraw permission at any time, and your care will not change if you do.

The practice must also have a certified electronic health record (EHR) system — not just any computer system, but one that meets Medicare's standards for security and data sharing. They must have a way to reach you and for you to reach them 24 hours a day, seven days a week, even if it is just an after-hours nurse line. And they must have a plan in place for what happens if you have an urgent problem outside office hours.

Finally, the office must document the time spent on your care — phone calls, find messages, care coordination with other doctors, medication reviews, and follow-up on test results. Medicare requires at least 20 minutes per month of documented work before they will pay the code. Many practices track this in their EHR system automatically, but some still do it by hand.

How much Medicare pays and what you owe

Medicare Part B pays a flat monthly fee when 99490 is billed. The amount varies slightly by region and by your specific Medicare plan, but it typically ranges from $42 to $50 per month. This is the total payment to your doctor's office — you do not owe anything out of pocket if you have Part B coverage.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan may or may not cover 99490, and the payment amount may be different. You should check your plan documents or call your plan's customer service to find out whether this service is covered and what your cost would be.

If you have a Medigap supplemental policy, it does not affect your cost for 99490 because Medicare covers it as a preventive service with no copay or coinsurance. Your Medigap policy will not charge you anything extra.

How to know if your doctor's office is billing 99490

The easiest way to find out is to ask your doctor's office directly: "Do you bill Medicare for chronic care management services?" If they say yes, ask them to confirm that you have signed the required permission form and that your conditions meet their criteria for billing.

You can also check your Explanation of Benefits (EOB) from Medicare. If 99490 has been billed, it will appear on your EOB with the date of service, the amount Medicare paid, and your cost (which should be zero). You can view your EOB online through your Medicare account at Medicare.gov, or request a paper copy by phone.

If you see 99490 on your EOB and you do not remember agreeing to this service, contact your doctor's office to ask about it. You have the right to refuse chronic care management services at any time, and the office must stop billing if you ask them to.

When 99490 might not be covered

Medicare will not pay 99490 if you have only one chronic condition, even if that condition is serious. The code requires a minimum of two conditions. If your doctor's office bills 99490 for a patient with only one chronic illness, Medicare will deny the claim and you should not be charged.

Medicare also will not pay if the practice does not have the required systems in place — a certified EHR, 24/7 patient access, and documented permission from you. If a practice tries to bill 99490 without meeting these requirements, Medicare denies the claim. Again, you should not be charged if this happens.

If you have a Medicare Advantage plan, check your plan's coverage rules. Some plans do not cover 99490 at all, or they may cover it only for certain conditions or only if the service is provided by in-network doctors. Your plan's customer service line can tell you what is covered under your specific plan.

Questions to ask your doctor about 99490

If your doctor's office mentions chronic care management or you want to know whether you are a candidate, here are the questions to ask:

  • Do you currently bill Medicare for chronic care management services using code 99490?
  • Do my conditions meet your criteria for this service?
  • What does this service include — phone calls, find messages, care coordination with my other doctors?
  • How will I know if you are billing for this, and how can I see it on my Medicare statement?
  • Can I stop this service at any time if I change my mind?
  • If I have a Medicare Advantage plan, is this service covered under my plan?

Frequently Asked Questions

Is 99490 the same as a telehealth visit?

No. A telehealth visit is a separate appointment where you talk to your doctor about a specific problem, and Medicare bills it as an office visit. Code 99490 is background care coordination work — your doctor's office managing your conditions between visits. You might have both in the same month, and they are billed separately.

Will my copay or deductible explore to 99490?

No. Medicare covers 99490 as a preventive service with no copay, coinsurance, or deductible. You owe nothing if your doctor's office bills it correctly and you have Part B coverage. If you are charged, contact Medicare to report it.

What if my doctor's office says they do not bill 99490?

Many practices do not offer this service because the documentation and system requirements are complex. If you have two or more chronic conditions and think you would benefit from more care coordination, ask your doctor whether they can refer you to a practice that does offer it, or whether they have other ways to coordinate your care.

Can I bill 99490 myself, or does my doctor's office have to do it?

Only your doctor's office can bill 99490. It is a code for work done by the practice, not by you. You cannot bill Medicare yourself for this service.

If I switch doctors, do I lose 99490 coverage?

Yes. Your new doctor's office would need to set up the same systems and get your written permission before they can bill 99490. There is no automatic transfer. If you are receiving 99490 from your current practice and plan to switch doctors, ask your new doctor whether they offer this service.