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See a sample rate comparisonCPT 99490 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Chrnc Care Mgmt Staff 1st 20, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Management Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | $66.13 national non-facility rate (2026) · View Medicare rates for 99490 |
| Medicaid Fee Schedule | $49.415 median of the 8 states in the free preview · View Medicaid rates for 99490 |
National average reimbursement for CPT 99490 by major payers:
$67.30
$54.18
$59.36
$87.67
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CPT 99490
5 of 25 sample ratesHigher to lower in this preview
Eric Small
$210.07Published rateBeata Malinowski
$82.68Published rateCaroline Chisholm
Carilion Healthcare Corporation
$63.91Published rateGary Sinclair
Aids Arms Inc
$46.93Published rateAzita Fakheri
Azita Fakheri, M.D, Inc.
$31.59Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99490 vs. Other Care Management Services Codes
The CPT 99490 code is part of the Evaluation and Management services used for Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99490 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99487-CPT | Low | Cplx Chrnc Care 1st 60 Min, Complex Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Moderate Or High Complexity Medical Decision Making First 60 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99489-CPT | Low | Cplx Chrnc Care Ea Addl 30, Complex Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Moderate Or High Complexity Medical Decision Making Each Additional 30 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure |
| 99490-CPT | Low | Chrnc Care Mgmt Staff 1st 20, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99491-CPT | Low | Chrnc Care Mgmt Svc 30 Min, Chronic Care Management Services Provided Personally By A Physician Or Other Qualified Health Care Professional At Least 30 Minutes Of Physician Or Other Qualified Health Care Professional Time Per Calendar Month With The Following Required Elements: Multiple (Two Or More) Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient; Chronic Conditions Place The Patient At Significant Risk Of Death Acute Exacerbation/Decompensation Or Functional Decline; Comprehensive Care Plan Established Implemented Revised Or Monitored. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99490 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services and procedures. These codes standardize the reporting of medical services, facilitating accurate billing and claims processing.
Healthcare costs can vary significantly due to several factors, including geographic location, the type of facility (e.g., hospital vs. outpatient clinic), the specific provider, insurance negotiated rates, the complexity of the procedure, and whether the provider is in-network or out-of-network. Different healthcare systems and market dynamics also play a role in price variations.
To find the cost of a specific medical procedure or service, especially for estimates based on CPT codes and your specific location, it's recommended to use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search using CPT codes and geographical locations to get an estimated cost. For your exact out-of-pocket costs, you should also contact your insurance provider directly.
The price of a medical service is influenced by many factors, including the provider's professional fees, facility fees (if applicable), geographic location, the complexity and duration of the procedure, the technology or equipment used, and whether the provider has negotiated specific rates with your insurance company. Demand, supply, and regulatory environments also contribute to pricing.
While CMS (Centers for Medicare & Medicaid Services) primarily provides extensive data on Medicare payment rates and policies, Payerprice offers a fee schedule lookup tool designed for broader use. Payerprice allows individuals to search with CPT codes and specific locations to get estimated costs for a wider range of services, which can be relevant for various payer types and insurance plans beyond just Medicare. It aims to provide more localized and potentially diverse pricing transparency.
Payerprice's fee schedule lookup tool can provide estimated costs for procedures based on CPT codes and your location, which is a crucial step in understanding potential expenses. However, your actual out-of-pocket costs will depend on your specific insurance plan, including deductibles, co-pays, co-insurance, and whether the provider is in-network. For exact out-of-pocket costs, you should combine the information from Payerprice with details from your insurance plan and a direct conversation with your provider.