Chronic care management companies enroll your Medicare patients, log the monthly care coordination minutes, and hand you documentation so your practice can bill CPT 99490 and its add-on codes. What they almost never do is put their own name on the claim. The claim goes out under your practice’s NPI, which means the revenue, the records, and the audit exposure all land on you.
That one fact should drive the whole evaluation. Most practices comparing chronic care management companies start with price, then work backward. The more useful order is to ask what share of the Medicare allowed amount you actually keep after the fee, whether the fee structure itself creates a compliance question, and whether you would still hold the time logs and consents if the relationship ended tomorrow. This guide walks through what these companies do, how they charge, where the risk sits, and nine questions worth asking before a signature.
What chronic care management companies actually do
The category covers two quite different business models that get marketed with the same language.
Full service staffing. The company supplies the people. Their clinical staff screen your panel for eligibility, obtain consent, build the care plan, make the monthly outreach calls, log time in their platform, and deliver a monthly billing file to you or your biller. This is what most people picture when they hear chronic care management companies.
Software only. The company licenses you a platform for eligibility tracking, consent capture, care plan templates, time logging, and billing reports. Your own staff do the calling. Several chronic care management companies sell both and will quote whichever one you ask about, so it is worth being explicit about which you are pricing.
Either way, the billing step usually stays with you. If you are still deciding whether the program itself fits your panel, start with our plain language guide to what chronic care management is and who qualifies, then come back to the vendor question.
How chronic care management companies charge, and why the structure matters
Three pricing structures dominate how chronic care management companies bill: a fee per enrolled patient per month, a percentage of what the program collects, and a flat platform license. Two of those three are worth slowing down on.
Start with the number you are dividing. For 2026, the national non-facility amount for CPT 99490, the first 20 minutes of clinical staff time in a calendar month, is $66.13. That figure comes from the CMS Physician Fee Schedule relative value file RVU26C released in July 2026, computed at the 2026 conversion factor of $33.4009, and it is not adjusted for your locality. Medicare Part B then pays 80 percent of the allowed amount once the annual deductible is met, so the program’s Medicare payment is roughly $52.90 per enrolled patient per month. The remaining $13.23 is patient coinsurance, and whether you collect it is a separate question entirely.
So when chronic care management companies quote a per patient per month fee, measure it against $52.90 of reasonably certain revenue, not against the $66.13 headline. A fee that sounds modest against the headline can look very different against the number that reaches your bank account.
Watch the unit math too. Under the CMS National Correct Coding Initiative practitioner file effective July 1, 2026, CPT 99490 carries a medically unlikely edit of 1 and the add-on CPT 99439 carries an MUE of 2. If a revenue projection stacks more units than that per patient per month, the projection is wrong before you get to any assumption about enrollment. Our CPT 99490 guide covers the base code requirements in detail.
The fee structure deserves its own review. Compensation arrangements that move with the volume or value of billed services sit in sensitive territory under the federal Anti-Kickback Statute. The personal services safe harbor at 42 CFR 1001.952(d) is written around aggregate compensation that is set in advance, consistent with fair market value, and not determined in a way that takes into account the volume or value of referrals or business generated between the parties.
Compliance with a safe harbor is voluntary and partial compliance earns no protection, so a percentage of collections arrangement is not automatically unlawful and not automatically safe. Ask chronic care management companies to state the fee basis in plain language, then have your health care counsel read the actual contract before you sign rather than after.
The compliance exposure sits with your NPI
This is the part that gets underweighted. When a program is delivered by one of the chronic care management companies but billed by you, an auditor reviewing those claims is reviewing your claims.
The HHS Office of Inspector General opened an audit of exactly this service line. Project OAS-26-09-007, announced March 16, 2026, examines Medicare payments for chronic care management services at risk of noncompliance, on the stated basis that Part B payments for CCM increased substantially from calendar year 2019 through calendar year 2024. The review looks at whether the patients billed actually met the multiple chronic conditions criteria.
The adjacent history on remote monitoring is worth reading before you sign with anyone. In its September 2024 data brief Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), OIG found that about 43 percent of enrollees who received remote patient monitoring did not receive all three components of it. The same report documented enrollment rising from roughly 55,000 Medicare enrollees in 2019 to slightly more than 570,000 in 2022, with payments climbing from $15 million to more than $300 million over the same period. OIG’s fifth recommendation to CMS was to identify and monitor the companies that bill for these services.
None of that makes vendors the villain. It does mean that when you evaluate chronic care management companies, the documentation question is not administrative housekeeping. Ask where the time logs, consents, and care plans physically live, whether they sit in your EHR or only in the vendor’s system, and what an export looks like. If the answer is a PDF bundle produced on request, you have a records problem waiting for an audit letter.
The proposed 2027 rule changes the vendor question for RPM and RTM only
In the CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P, published at 91 FR 43842 on July 16, 2026), CMS proposed to pay for remote physiologic monitoring and remote therapeutic monitoring only when those services are furnished by clinical staff who are direct employees of the billing practitioner or the practice. If that provision is finalized as written, contracting those services out to a third party would no longer support Medicare billing beginning January 1, 2027.
Two clarifications matter, because a lot of the commentary gets them wrong. First, this is a proposed rule. The comment period runs to September 14, 2026, and CMS has softened proposals before. Second, the staffing provision covers RPM and RTM. It does not restrict outsourced chronic care management or principal care management. If a salesperson tells you Medicare is banning outsourced CCM, that is not what the rule says.
Practices already running monitoring through chronic care management companies have the most to work through here. We keep a plain language explainer of the proposed staffing rule and a 2027 RPM and RTM transition checklist current as the rule moves, alongside the RPM code set and PCM codes.
9 questions to ask chronic care management companies before you sign
Take these into the next call with every vendor on your shortlist. The answers separate the chronic care management companies that have built this before from the ones selling a demo.
- Who employs the staff who speak with our patients? Direct employees, subcontractors, or an offshore partner. Get it in writing, because it determines both patient experience and how exposed you are if the 2027 staffing proposal is finalized.
- How is your fee calculated, and does it vary with what we bill or collect? Chronic care management companies price this three different ways, and a flat fee set in advance is the cleanest structure to defend.
- Do we own the time logs, care plans, and consent records, and can we export them on demand in a readable format? Ask to see a sample export, not a description of one.
- What happens to enrolled patients if we terminate? Notice period, records transfer, and whether the vendor contacts your patients after the contract ends.
- Who explains the 20 percent coinsurance to the patient, and what exactly does that script say? This is where enrollment succeeds or stalls, and it is your patients hearing it.
- What is your documented process when a patient does not reach the required minutes in a month? The only correct answer is that the month does not get billed.
- How do you detect that another practice already billed care management for this patient this month? Only one practitioner can bill it per patient per calendar month.
- Will you sign a business associate agreement, and what is your breach notification commitment? Ask for their most recent security assessment while you are at it.
- If the 2027 staffing proposal is finalized, what is your plan for our RPM and RTM lines? A vendor without a real answer is telling you something.
When chronic care management companies are the right call
Bringing everything in house is not automatically better than hiring one of the chronic care management companies on your list, and we would rather say so plainly than pretend otherwise.
If your eligible panel is small, a coordinator’s salary does not amortize across enough patients to work, and a per patient fee may cost you less than a partly idle employee. If you want to prove the model before committing to a hire, a vendor is a reasonable pilot. And if you have no platform, chronic care management companies bundle software you would otherwise buy and configure yourself. The economics tend to favor building in house as the enrolled panel grows and as one coordinator stacks care management minutes across several programs, but that crossover point is specific to your panel and your staffing costs.
What in house actually costs
Rather than restate the arithmetic here, we built a tool for it. Our in house versus vendor revenue calculator takes your enrolled patient count, your coordinator’s fully loaded cost, and a vendor fee, and shows the monthly and annual difference between the two models using published Medicare national amounts. It is the fastest way to find out whether the quote from the chronic care management companies you are considering is competitive for your specific panel size.
What we learned implementing one of these programs
We are not writing this from the outside. Our team designed and implemented an in house care management program at our own clinic, a musculoskeletal and regenerative medicine practice, and we support it on an ongoing basis. The clinic’s own staff run it day to day. It is a remote therapeutic monitoring and principal care management program rather than a CCM program, because that is what fits that patient population, and being specific about that seems more useful than implying broader experience than we have.
Three things surprised us, and all three are worth raising with any of the chronic care management companies you evaluate. The binding constraint was never the software. It was minutes and consent, in that order. The coinsurance conversation is where enrollment stalls, so whoever owns that script matters more than the platform’s feature list. And documentation discipline decays quietly, which is why we would not accept a records arrangement, from chronic care management companies or from our own team, that leaves the logs somewhere we cannot reach on a Tuesday afternoon.
It also shapes how we contract. On our own care management implementation work we charge flat fees set in advance, never a per patient fee and never a percentage of collections, for the same reason we suggest you scrutinize that structure in a vendor agreement. We design, build, and support the program. We do not run it, and we do not submit claims.
Frequently asked questions
Do chronic care management companies submit the claim for us?
Usually not. Most chronic care management companies deliver a monthly billing file and your practice or your biller submits the claim under your NPI. Confirm this in the contract, because it determines who is answerable for the claim if it is later reviewed.
Can we bill 99490 for a patient another practice already bills?
No. Only one practitioner may bill chronic care management for a given patient in a given calendar month. Ask any vendor how their enrollment process detects an existing program elsewhere, because a duplicate is a denial at best.
Does the proposed 2027 staffing rule ban outsourced chronic care management?
It does not. The staffing provision in CMS-1848-P applies to remote physiologic monitoring and remote therapeutic monitoring. Chronic care management and principal care management are not covered by it. The rule is also still proposed rather than final.
What does chronic care management pay in 2026?
The 2026 national non-facility amount for CPT 99490 is $66.13 for the first 20 minutes of clinical staff time in a calendar month, with $50.44 for each additional 20 minutes under CPT 99439. Those are national amounts before locality adjustment, and Medicare pays 80 percent of the allowed amount after the deductible.
How do we compare chronic care management companies on price?
Convert every quote to a dollar amount per enrolled patient per month, then compare it against the roughly $52.90 that Medicare pays on a 99490 month. Chronic care management companies quote in different units, so a percentage of collections and a flat platform license only become comparable once both are expressed that way.
How long does it take to bring a program in house?
It depends on hiring more than anything else. The work itself is panel analysis, program selection, a staffing plan, platform configuration, workflows and consent scripts, and quality assurance on the first billing cycles. The step practices consistently underestimate is the enrollment conversation, not the setup.
Where to start
If you are actively comparing chronic care management companies, run the quote through the calculator first, then take the nine questions above into your next vendor call. If you would rather look at whether an in house program fits your panel before you talk to anyone, that is the assessment we do. You can tell us about your practice or email contact@practicemanagementconsultancy.com.
Sources
- HHS Office of Inspector General, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed, OEI-02-23-00260, September 2024.
- HHS Office of Inspector General Work Plan, Audit of Medicare Payments for Chronic Care Management Services at Risk of Noncompliance, OAS-26-09-007, announced March 16, 2026.
- CMS, CY 2027 Physician Fee Schedule proposed rule CMS-1848-P, 91 FR 43842, July 16, 2026.
- CMS Physician Fee Schedule relative value file RVU26C, July 2026 release, national non-facility amounts at the 2026 conversion factor of $33.4009.
- 42 CFR 1001.952(d), personal services and management contracts safe harbor.
This article is general information for practice owners and is not legal, billing, or compliance advice for a specific arrangement. Medicare rates shown are national non-facility amounts and are not adjusted for your locality.
Disclosure: our team operates and manages the medical practice referenced in first-person examples on this site.
