Medicare Chronic Care Management Reimbursement Rate – Updated by Region

The Medicare reimbursement for CPT codes 99490, 99487 and 99489 can be claimed by care providers who offer chronic care management to their patients suffering from two or more chronic conditions. The care provided under CCM with advanced consent includes:

  • Continuity of Care with Designated Care Team Member
  • Comprehensive Care Management and Care Planning
  • Coordination with Home- and Community-Based Clinical Service Providers
  • 24/7 Access to Address Urgent Needs
  • Enhanced Communication (for example, email, app notifications)

The USA average reimbursement rate for CPT 99490 is $42 per consultation per patient. Each patient may be billed under CPT 99490 once per month. In 2017 the Medicare reimbursement rates were revised for 89 locations across the USA. The below table lists the chronic care management reimbursement rates for CPT 99490 in the revised locations.

Region CCM Reimbursement for CPT 99490
USA Average $41.44
Alabama $38.26
Alaska $53.20
Arizona $40.64
Arkansas $37.82
California Anahiem / Santa Ana $45.24
California Los Angeles $44.54
California Marin / Napa/ Solano $46.40
California Oakland / Berkley $45.93
California San Francisco $48.57
California San Mateo $48.23
California Santa Clara $47.99
California Ventura $44.39
California Rest of California $42.37
Colorado $41.14
Connecticut $43.80
DC + MD / VA Suburbs $45.93
Delaware $41.74
Florida Fort Lauderdale $42.37
Florida Fort Lauderdale $42.37
Florida Miami $43.53
Florida, Rest of Florida $40.57
Georgia, Atlanta $40.82
Georgia, Rest of Georgia $38.91
Hawaii/ Guam $43.18
Idaho $38.32
Illinois, Chicago $43.27
Illinois, East St Louis $40.93
Illinois, Suburban Chicago $42.99
Illinois, Rest of Illinois $39.58
Indiana $38.88
Iowa $38.27
Kansas $38.63
Kentucky $38.28
Louisiana, New Orleans $41.08
Louisiana, Rest of Louisiana $39.13
Maine, Southern Maine $40.43
Maine, Rest of Maine $38.87
Maryland, Baltimore / Surr. Cntys $43.28
Maryland, Rest of Maryland $41.73
Massachusetts, Metropolitan Boston $43.50
Massachusetts, Rest of Massachusetts $41.80
Michigan, Detroit $40.18
Michigan, Rest of Michigan $39.35
Minnesota $40.19
Mississippi $37.88
Region CCM Reimbursement for CPT 99490
Missouri, Metropolitan Kansas City $40.01
Missouri, Metropolitan St Louis $40.06
Missouri, Rest of Missouri $38.07
Montana $41.14
Nebraska $38.29
Nevada $41.80
New Hampshire $41.65
New Jersey, Northern New Jersey $45.01
New Jersey, Rest of New Jersey $43.68
New Mexico $39.63
New York, Manhattan $45.99
New York, NYC Suburbs / Long Island $47.23
New York, Poughkeepsie/ NYC Suburbs $43.03
New York, Queens $47.14
New York, Rest of New York $39.51
North Carolina $39.26
North Dakota $40.18
Ohio $39.37
Oklahoma $38.35
Oregon, Portland $41.37
Oregon, Rest of Oregon $39.82
Pennsylvania, Metropolitan Philadelphia $43.18
Pennsylvania, Rest of Pennsylvania $39.55
Puerto Rico $34.63
Rhode Island $41.88
South Carolina $38.86
South Dakota $39.96
Tennessee $38.35
Texas, Austin $40.82
Texas, Beaumont $39.03
Texas, Brazoria $40.99
Texas, Dallas $41.04
Texas, Fort Worth $40.51
Texas, Galveston $41.40
Texas, Houston $41.27
Texas, Rest of Texas $39.16
Utah $39.69
Vermont $40.43
Virginia $40.27
Virgin Islands $40.11
Washington, Seattle ( King Cnty) $43.36
Washington, Rest of Washington $40.33
West Virginia $38.34
Wisconsin $39.41
Wyoming $41.13
The tabular data is for estimation only. It is not a legally bound guarantee of results. Please check for revised rates in your area. HealthViewX is not liable for the accuracy of this content. The data is for calculation estimation only.
Reference:
1) CMS.gov – County Level Multiple Chronic Conditions (MCC) Table: 2012 Prevalence, National Average.
2) Reimbursement amount from the CY 2015 Physician Fee Service Final Rule, October 31, 2014, averaged across 89 localities.
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Medicare Chronic Care Management Reimbursement Rate - Updated by Region
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Medicare Chronic Care Management Reimbursement Rate - Updated by Region
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The USA average reimbursement rate for CPT 99490 is $42 per consultation per patient. Each patient may be billed under CPT 99490 once per month. In 2017 the Medicare reimbursement rates were revised for 89 locations across the USA. The below table lists the chronic care management reimbursement rates for CPT 99490 in the revised locations.
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