CMS finalized roughly a 10% increase in Chronic Care Management reimbursement across all CCM codes in the CY2026 Physician Fee Schedule — one of the larger annual increases in the program’s history — and continued expanding Advanced Primary Care Management.
That is CMS saying something plainly with money: manage chronic disease between visits, and we will pay you for it. The question worth asking your own organization is whether you actually are.
1. What CMS built and what it now pays
CCM has existed since 2015 for patients with two or more chronic conditions expected to last at least twelve months, covering non-face-to-face care coordination delivered between visits. The CY2026 fee schedule raised reimbursement across the CCM code family by about 10%, driven by the largest conversion factor increase in several years.
Alongside it, Advanced Primary Care Management — the HCPCS codes CMS introduced in 2025 and expanded for 2026 — bundles care-management elements into a single monthly payment tiered by patient complexity, without a minimum time threshold. Practices are paid for keeping capability available rather than for logging minutes. Exact rates vary by locality; check the fee schedule for your area rather than relying on national averages.
2. The shift hiding inside APCM
Time-based billing pays you for effort. Complexity-based billing pays you for knowing who your patients are.
This is the part I would flag for anyone running population health. Under time-based CCM, the operational challenge was tracking minutes. Under APCM, payment is tiered by patient complexity — which means your ability to accurately identify and document complexity determines your reimbursement.
That is a meaningful convergence. Patient identification, clinical documentation, and care-management revenue are becoming the same capability rather than three separate workstreams.
3. Why it stays underused — the honest reasons
CCM has been billable for a decade and remains widely under-utilized. The reasons are operational rather than clinical: consent requirements, contemporaneous time documentation, care-plan standards, and monthly billing thresholds that demand front-office workflow redesign most practices never did.
Denial rates on manually managed CCM programs are reportedly substantial, which compounds the discouragement — a program that generates denials feels like a failed experiment rather than an under-built one. Treat those vendor-reported denial figures as directional rather than precise, but the direction is real.
4. The reason this matters beyond the fee
For a fee-for-service practice, CCM and APCM are incremental revenue. For a risk-bearing organization, they are something more useful: a funded mechanism for exactly the between-visit management that reduces avoidable utilization.
You are being paid, separately, to do the thing your value-based contract already requires. Most organizations are leaving that alignment on the table — running care management as a cost center while a payment stream designed to fund it goes unclaimed.
5. Where to start
Identify your eligible population honestly — patients with two or more qualifying chronic conditions, which in most Medicare panels is a large share. Then examine the workflow rather than the codes: who obtains consent, who documents the care plan, who captures time or complexity, and where that breaks.
And align it with your rising-risk work. The patients who most need structured between-visit management are the same ones your stratification should already be flagging. If your care-management list and your CCM-eligible list are maintained by different people who never speak, that is your first fix.
Final Thoughts
It is rare for CMS to raise payment for something and for the field to largely not respond. That is roughly what has happened with chronic care management for a decade.
As someone trained as a physician who later worked in coding and audit, I read the CY2026 changes as a genuine alignment moment: the payment, the clinical need, and the value-based incentive finally point the same direction. The organizations that build the workflow — not just the billing — will get paid to do the work they were going to have to do anyway.
If your care-management program and your chronic-care-management billing are run by different teams who never compare lists, you are funding out of pocket what CMS is willing to pay for. At HealtheNomics I help organizations align rising-risk identification with the care-management payment mechanisms designed to support it.
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