Medicare’s reimbursement for Chronic Care Management (CCM) and Principal Care Management (PCM) is built entirely around a set of very specific CPT codes. These codes - 99490, 99439, 99424, and 99425 - are what unlock recurring revenue for clinics. They determine how much time must be spent, who must perform the work, and what documentation must exist for a claim to be billable.

In other words, CCM and PCM are not simply care programs, they are structured billing frameworks driven by time-based CPT requirements. When clinics do not understand the nuances of these codes or fail to meet their documentation standards, reimbursement is lost immediately. And this is exactly where most clinics struggle. This guide breaks down the CPT codes that drive CCM and PCM and explains how we help clinics stay compliant while maximizing reimbursement.

The CPT Codes That Power CCM & PCM: What They Require and Why They Matter

Although CCM and PCM aim to improve patient outcomes, their financial value comes entirely from the CPT codes themselves. These codes define the minimum time needed, the type of clinician required, and the average reimbursement per month. Understanding these codes is the first step to understanding how to operationalize the programs.

CCM: Chronic Care Management Codes

CPT 99490 - Base CCM

This is the foundational CCM code. It requires at least 20 minutes per month of clinical staff time under general physician supervision. The average national reimbursement is approximately $62 per month. This code is used for the majority of routine chronic-care follow-ups.

CPT 99439 - Add-On CCM

Once the first 20 minutes are met, every additional 20-minute block can be billed using 99439. Each additional unit reimburses around $47. This code captures all the extra work clinics typically do for complex patients, but only if the time is documented clearly.

PCM: Principal Care Management Codes

CPT 99424 - Base PCM

PCM requires that the clinician (physician, NP, or PA) personally provides at least 30 minutes of care-management oversight each month. The national average reimbursement is roughly $83. This code reflects conditions where one chronic issue dominates the patient’s clinical picture—common in specialties like neurology.

CPT 99425 — Add-On PCM

This add-on code is billed for every additional 30 minutes of clinician time. It reimburses approximately $60 per unit.

These CPT codes form the financial foundation that makes between-visit care sustainable. Our job is to ensure no billable minute is missed.

What Counts as Billable Time for CCM and PCM

A common question among clinics is: what actually counts toward billable minutes? In short, any medically necessary activity that supports the patient’s chronic condition, outside of an in-person visit, can often be counted. This includes phone calls with the patient or caregiver, reviewing labs or imaging, medication reconciliation, updating a care plan, coordinating with specialists, reviewing RPM data, arranging follow-ups, documenting symptom changes, or providing counseling and self-management support.

The key is that the activity must advance the patient’s care. If it prevents decline, improves adherence, or provides necessary clinical oversight, it likely qualifies. We document and categorize every billable minute for the clinic, ensuring nothing is lost to incomplete notes or inconsistent workflows.

Average Medicare Reimbursement: What Practices Can Expect

When clinics meet the time thresholds and maintain complete documentation, Medicare reimburses monthly. This creates a dependable revenue stream, often outperforming many traditional service lines in consistency.

For CCM, clinics generally earn between $62 and $200+ per patient per month depending on add-on units. For PCM, reimbursement generally ranges from $63 to $200+ per patient per month, especially when clinician time accumulates.

The difference between a clinic earning on the lower end versus the higher end usually comes down to documentation rigor, and that’s where we add enormous value. Because we maintain adherence, time tracking, and documentation, clinics see significantly higher completion rates, fully captured add-on units, and cleaner billing.

Why These CPT Codes Matter Clinically, Not Just Financially

Although CCM and PCM are billing mechanisms, they produce meaningful clinical improvements. Monthly follow-up creates a predictable structure for monitoring symptoms, adjusting medications, identifying early changes in condition, and addressing barriers before they escalate. Patients become more adherent. Clinicians catch problems sooner. Hospitalizations drop. Care becomes proactive instead of reactive.

CPT codes aren’t just billing units, they are the scaffolding that allows chronic patients to receive continuous care and lets clinics build systems around that care. When we run these programs, clinics see better outcomes without taking on more work. We handle all operational aspects, and clinicians stay focused on the medical decisions that only they can make.

Conclusion

CCM and PCM work because of their CPT codes. These codes define the minimum time, the eligible staff, the documentation standards, and the reimbursement structure. But this also means that clinics must operate with precision in order to benefit. Most clinics don’t have the internal bandwidth to maintain the minute-level tracking, monthly follow-up, and documentation disciplines required. That’s why outsourced CCM and PCM programs have become the dominant model.

At Foresight Health, we manage CCM and PCM end-to-end - outreach, monthly calls, documentation, time tracking, staffing, compliance oversight, and billing preparation - so clinics receive the full financial and clinical value of these programs without increasing their workload. CCM and PCM convert essential chronic-care tasks into reimbursed, structured care. With the right partner, these programs become a stable foundation for improved outcomes and long-term financial sustainability.