If you read anything about Medicare's 2026 fee schedule over the winter, you probably saw a version of the same headline: chronic care management got a raise of more than 10%. That's close to right for about half the teams who read it, and backwards for the other half.
Here's what actually happened to the money, read out of Medicare's own fee schedule tool rather than out of the coverage.
What chronic care management rates pay in 2026
99490 is the workhorse. Per CMS, it covers the first 20 minutes of clinical staff time in a calendar month for a patient with two or more chronic conditions expected to last at least a year. 99439 is the add-on for each additional 20 minutes.
Billed in the office setting, 99490 pays $66.13 this year. That's an increase of 9.3%, and it's real money on a panel of any size.
Those are national amounts. Medicare adjusts every one of them by locality, so what lands in your area will sit a few dollars either side of the figure above.
The facility rate moved the other way
Each of these codes carries a second price, the one Medicare uses when the service is billed from a facility setting. In practice that means a hospital-owned practice or a provider-based clinic, which is where a lot of care management teams now sit.
That price went down.
In dollars, 99490 went from $47.87 to $43.76 and the add-on went from $32.99 to $30.73. So the same 20 minutes of care coordination, documented to the same standard, now pays about $22 more in one setting than in the other.
If your organization moved its care management team under the hospital's billing in the last few years, this is the year that decision turns up in the budget.
Why the two settings split
This wasn't the annual inflation update, and that's the part worth understanding, because it means the gap isn't going to close next year.
CMS rebuilt how it allocates indirect practice costs, and it's explicit about the intent.
We are finalizing to recognize greater indirect costs for practitioners in office-based settings compared to facility settings.
CMS, CY 2026 Physician Fee Schedule final rule fact sheet
The reasoning is that the old method assumed a physician kept an office running even when the care happened inside a hospital, and that stopped matching reality as more clinicians moved onto health system payroll. On 99490 specifically, the practice expense value went from 0.81 to 0.91 in the office setting and from 0.42 to 0.24 in the facility setting. That single change is most of the gap you see above.
The second reason is something that didn't happen. CMS also finalized an efficiency adjustment that trims the work value of many services, and it exempts time-based codes, naming care management services in the exclusion list. So the work value on 99490 held at 1.00 while plenty of other codes were cut. Care management came out ahead partly by being left alone.
There are two 2026 rates, not one
One more wrinkle that quietly breaks budget spreadsheets. Starting this year there are two conversion factors, the multiplier that turns a code's relative value into dollars. Practices that qualify as advanced alternative payment model participants are paid on $33.5675. Everybody else is paid on $33.4009.
On 99490 that's the difference between $66.46 and $66.13. Small on one claim, less small across a panel of two thousand patients, and worth knowing which number your finance team used. Every figure in this article is the nonqualifying rate, because that's what most teams are paid under.
What to check before you sign off on a 2026 budget
Three things, and none of them take long.
None of this changes the case for running a care management program. The office-side panel pays better than it did last year and the work didn't get harder. What changed is that the setting now carries real money, and the number sitting in your model is probably from a year ago.
The teams that handle this well are the ones who can produce time, goals and progress per patient per month without going hunting for it. That's a records question before it's a billing question, and it's the argument for running care management on a platform built for chronic care teams rather than on an EHR note and a shared drive.
