Boris Dobrin on What the 2026 Medicare Reimbursement Increase Means for Chronic Care Management

CMS increased 2026 reimbursement rates for chronic care management, but Dobrin says capturing that revenue requires well-thought-out processes.

In July 2026, the Centers for Medicare & Medicaid Services launched the ACCESS model, a 10-year pilot to test whether technology-supported tools can improve outcomes for patients with chronic conditions. The program is one signal that Medicare sees the value of ongoing, structured chronic care management.

This year’s fee schedule update also included increases for CPT codes related to chronic care management. Boris Dobrin, founding leader of chronic care management platform CareSpace, says the increase is a meaningful signal but not a revenue windfall for practices. While the CY 2026 Medicare Physician Fee Schedule includes an increase of around 8%-11% for all CCM-related CPT codes, long-term success is less about the numbers on that schedule and more about a practice’s ability to capture revenue.  

What Are the CPT Codes for Chronic Care Management?

Even with rate increases, capturing the full revenue value of CCM programs requires understanding every CPT code available to your practice. Each code reflects time, complexity and who performed the service.

The main CPT codes used in billing chronic care management services include:

• 99490. Covers the first 20 minutes of clinical staff time per calendar month for non-complex CCM as performed under the general supervision of a physician or qualified health professional (QHP).
• 99439. Each additional 20 minutes of clinical staff time for non-complex CCM, performed under the supervision of a physician or QHP.
• 99491. Covers the first 30 minutes of non-complex CCM personally performed by a physician or QHP each calendar month.
• 99437. Each additional 30 minutes of non-complex CCM personally performed by a physician or QHP.
• 99487. Covers the first 60 minutes of complex CCM each calendar month.
• 99489. Each additional 30 minutes of complex CCM.

Changing Rates for Chronic Care Management CPT Codes

The updated fee schedule for 2026 included increases for all of these codes.

Billing Code	2025 Reimbursement Rate	2026 Reimbursement Rate	Percent Change
99490	$60.49	$66.13	9.3%
99439	$45.93	$50.44	9.8%
99491	$82.16	$89.18	8.5%
99437	$57.58	$63.13	9.6%
99487	$131.65	$144.29	9.6%
99489	$70.52	$78.16	10.8%

Source: CMS Physician Fee Schedule, MAC Option: National Payment Amount

Dobrin’s point about the specific fees mattering less than the ability to capture this revenue at scale makes sense when you look at the increase amounts. Most are under $10, which isn’t enough to tip the financial scales for any medical practice.

But consider a hypothetical:

A three-physician practice has 150 CCM-enrolled patients. One hundred of those patients require non-complex CCM services, while 50 require complex. Of those totals, 40 of the non-complex patients require enough time in the month for an additional 20-minute billing code, and 20 of the complex patients require enough time for an additional 30-minute billing code.

Here’s how the revenue math breaks down in such a scenario.

Code	Patients	2025 Monthly Total	2026 Monthly Total	Increase
99490	100	$6,049.00	$6,613.00	$564.00
99439	40	$1,837.20	$2,017.60	$180.40
99487	50	$6,582.50	$7,214.50	$632.00
99489	20	$1,410.40	$1,563.20	$152.80

While the increase is only a few dollars for each code, in this hypothetical, the total monthly increase in CCM revenue for the practice is $1,529.20. That’s an increase of more than $18,000 for care that the providers are already spending time on.

Note: These hypotheticals are based on national non-facility average reimbursement rates, as published by Medicare. Actual reimbursement totals depend on provider location and other factors. 

How CCM Providers Can Maximize Rate Increase Benefits

A bump in payment rates for monthly CPT codes is only a win for providers who can capture that revenue effectively. Dobrin champions an organized approach that leverages technology tools and expert help to implement tips like those below.

Delegating Non-Complex Care Can Help Protect Margins

Non-complex CCM covers two billing options: clinical staff performing the work under supervision or a physician/QHP performing it personally. While the physician/QHP-direct codes have higher payment rates, physician time is typically one of a practice’s most expensive and limited resources. By delegating non-complex care to clinical staff, practices can protect margins, particularly when higher-value work is required of physicians.

Practices may want to:

• Assign non-complex CCM calls, medication reconciliation and care plan updates to trained clinical staff.
• Reserve direct performance of CCM by physicians for situations that require ongoing physician-level judgment.
• Build staffing models around clinical staff time to support non-complex CCM programs so physicians can take on more complex cases. 

Practices Should Ensure They’re Billing for the Right Complexity

Complex CCM requires medical decision-making of moderate or high complexity, and it reimburses significantly more. Practices that default patients into non-complex coding without reassessment protocols may be underbilling for the work done.

• A patient with two stable chronic conditions and infrequent medication changes may fit non-complex CCM.
• A patient with multiple chronic conditions requiring frequent medication adjustments, coordination across specialists or an elevated risk of hospitalization may meet the threshold for complex CCM.
• A patient’s status can change over time, so a care plan reflecting complex CCM criteria today may not have applied when they first enrolled.

Time Tracking Helps Capture All Add-On Billables

When staff don’t track and document care time accurately, practices can lose out on revenue associated with codes like 99439 and 99489. Automated tracking tools can help reduce this issue by:

• Flagging when a patient’s monthly care time may be approaching maximum minutes allowed, as providers can only bill two 20-minute add-on sessions for non-complex, supervised CCM work each month
• Creating an audit-ready record regarding care time logged to support claims appeals, if necessary
• Reducing the administrative burden on clinical staff, so tracking doesn’t compete with patient care