How much does Medicare pay for CPT 99490?

Medicare allowed an average of $59.70 per service and paid $45.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $112.75, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99490?

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month. It was billed 6,682,760 times to 1,505,972 Medicare beneficiaries by 18,757 providers in 2024.

Does 99490 pay differently in an office than a hospital?

Yes. The allowed amount averaged $60.10 in an office setting and $46.08 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99490 most?

Internal Medicine, with 1,956,392 services from 4,286 clinicians. Next are Family Practice, Nurse Practitioner, Cardiology.

CPT 99490

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month

$59.70Medicare-allowed amount per service, averaged across 6,682,760 services

Providers submitted

$112.75

Asking price, not received

Medicare allowed

$59.70

The fee schedule figure

Medicare paid

$45.41

Balance is patient coinsurance

Providers submitted an average of $112.75 for this code and Medicare allowed $59.70 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $45.41 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $60.10
Hospital / facility: $46.08

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 6,493,683 services were billed in an office setting and 189,077 in a facility.

Services: 6,682,760
Beneficiaries: 1,505,972
Providers billing it: 18,757
Total allowed: $398,960,772

What Medicare pays for CPT 99490

Across 6,682,760 services billed by 18,757 providers to 1,505,972 beneficiaries, Medicare allowed an average of $59.70 per service. That is 4.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99490

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	1,956,392	409,519	$61.44	4,286
Family Practice	1,447,618	298,612	$59.08	4,427
Nurse Practitioner	774,878	236,670	$51.88	3,965
Cardiology	414,965	71,651	$62.49	538
Geriatric Medicine	405,145	114,623	$62.42	86
Urology	372,655	71,666	$62.09	1,133
Nephrology	239,358	49,694	$59.15	962
Physician Assistant	205,443	58,303	$52.06	893
Gastroenterology	134,099	25,486	$61.38	547
Interventional Cardiology	90,540	14,363	$61.97	150
Pulmonary Disease	78,466	15,764	$61.33	181
Endocrinology	73,391	14,938	$61.73	137
General Practice	59,662	14,965	$61.94	164
Emergency Medicine	51,520	16,630	$63.68	96
Hematology-Oncology	51,037	11,405	$66.62	137

99490 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	668,870	$65.02	$46.19	1,340
Texas	623,341	$59.36	$45.62	1,775
Florida	595,701	$60.58	$45.85	1,349
New York	543,266	$64.71	$44.86	1,307
Connecticut	449,248	$62.97	$47.86	173
Georgia	265,118	$58.09	$45.32	843
Virginia	247,568	$61.31	$44.83	716
Arizona	227,445	$57.62	$44.97	599
North Carolina	203,583	$55.42	$44.29	799
New Jersey	195,870	$66.32	$46.42	615
Illinois	181,642	$61.27	$45.80	720
Pennsylvania	178,745	$57.31	$43.87	705
South Carolina	163,743	$57.88	$45.47	647
Alabama	154,064	$56.59	$46.61	464
Kentucky	144,508	$39.70	$32.37	318
Tennessee	137,531	$56.83	$44.71	444
Missouri	129,205	$59.30	$46.98	225
Maryland	125,355	$62.55	$45.16	301
Michigan	118,297	$59.67	$45.14	516
Indiana	118,250	$55.94	$45.12	448
Mississippi	112,545	$55.03	$44.11	339
Louisiana	106,945	$56.73	$44.57	348
Iowa	95,009	$56.28	$44.91	353
Ohio	92,854	$55.64	$43.69	462
Oklahoma	80,988	$57.22	$45.36	191
Colorado	71,849	$57.57	$43.26	387
Nevada	70,972	$59.70	$45.61	213
Kansas	69,706	$52.75	$42.33	233
Arkansas	64,581	$55.53	$44.42	156
Nebraska	64,311	$56.12	$44.33	185
Massachusetts	61,954	$62.76	$45.05	241
Delaware	56,665	$59.62	$45.64	116
New Mexico	48,920	$54.84	$43.34	165
Washington	34,954	$57.88	$44.28	140
Idaho	24,936	$52.29	$43.15	96
West Virginia	21,129	$50.21	$40.47	95
Wisconsin	19,730	$58.12	$45.70	95
Minnesota	16,330	$57.70	$43.45	212
Utah	15,819	$55.81	$44.06	85
Oregon	14,805	$59.17	$46.01	79
Rhode Island	10,653	$58.18	$44.20	26
New Hampshire	9,328	$53.24	$40.71	22
District of Columbia	7,447	$60.81	$46.00	25
South Dakota	7,061	$60.44	$46.18	25
Wyoming	6,703	$56.12	$41.66	37
Maine	5,853	$55.80	$42.37	17
Montana	5,270	$57.91	$44.47	32
Hawaii	4,767	$62.24	$46.11	19
North Dakota	4,513	$48.67	$37.75	18
Alaska	2,727	$75.90	$45.28	18
Guam	1,128	$65.36	$44.85	5
Vermont	374	$59.66	$45.67	11
Puerto Rico	287	$62.32	$48.78	2
U.S. Virgin Islands	271	$58.41	$44.33	4
ZZ	26	$50.76	$37.08	1

Related codes

99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08
99484Care management services for behavioral health conditions$50.05

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.