I've written about CCM under-enrollment before. The number I keep coming back to is this: roughly 22 million Medicare beneficiaries are eligible for Chronic Care Management. As of the most recent data, only about 882,000 of them — roughly 4% — are actually enrolled.
Think about that for a moment. A program that's been available since 2015, that saves Medicare money on the patients who use it, that requires no new clinical staff and no new technology — and after more than a decade, only 4% of eligible patients are using it.
There are several reasons for that gap. One of them may be about to change.
In April 2026, Representatives Suzan DelBene (D-WA-01) and Mike Kelly (R-PA-16) introduced the Chronic Care Management Improvement Act of 2026 — bipartisan legislation with a single, targeted change: eliminate the 20% patient cost-sharing requirement for CCM services.
Under current Medicare policy, patients enrolled in CCM owe a 20% coinsurance for the monthly service. For a patient on CPT 99490 (which reimburses $66.13/month at 2026 rates), that's roughly $13 out of pocket — every month, for a service that in many cases doesn't involve a face-to-face encounter. Patients see the bill and don't always understand what they're being charged for. Many opt out. Many others never enroll in the first place once they hear there's a monthly cost.
The bill would eliminate that coinsurance entirely, making CCM free to the patient. The practice still bills and gets paid — the change is only on the patient's side of the ledger.
As of this writing, the bill has the support of more than 40 national organizations, including the AHA, AMA, AARP, the American Diabetes Association, the American College of Physicians, the National Rural Health Association, MGMA, Premier, and dozens of patient advocacy groups. That's a broad coalition, and it signals real momentum.
Talk to any practice that's tried to enroll patients in CCM and you'll hear the same conversation. The clinical conversation goes well. The patient understands the value of monthly care coordination. Then comes the financial disclosure: there's a small monthly cost, a fraction of what most copays look like — and the patient says "I'll think about it." Many never come back.
This isn't unique to CCM. Patient cost-sharing is a well-documented adoption barrier across Medicare benefits. Even small recurring costs disproportionately suppress utilization in fixed-income populations — which is exactly the population CCM is designed to serve. Removing the coinsurance isn't a giveaway. It's removing a friction point that is actively suppressing enrollment in a program that benefits the patient, the practice, and Medicare alike.
The legislation hasn't passed yet — as of May 2026, it's working through the committee process. But there are two reasons it matters to you now, before it becomes law.
First, practices that already have a functioning CCM infrastructure are the ones that will benefit immediately if and when the barrier drops. If the cost-sharing requirement goes away, patient enrollment resistance goes down. A patient who said no to CCM because of the monthly bill might say yes in a post-coinsurance world. Practices with an enrollment process already built will be able to scale fast. Practices starting from zero will spend the first six months building infrastructure instead of enrolling patients.
Second, the debate around this legislation is driving attention to CCM generally. Payers, administrators, and patients are reading about it. Some patients are asking their providers about it. That's an opportunity to have the conversation proactively — to explain to eligible patients what CCM is, what it includes, and why it's worth enrolling in even with the current cost-sharing in place.
The data on CCM outcomes is strong. Medicare spends less on actively-managed CCM patients. Patients with care plans and regular coordination have fewer hospitalizations, fewer gaps in treatment, and better medication adherence. The program works. The barrier has been cost-sharing confusion and administrative friction — and legislation is now targeting the cost-sharing piece directly.
For practices currently at 4% CCM penetration of their eligible panel — which is roughly the national average — removing the patient cost-sharing barrier could be significant.
Walk through the math for a typical primary care practice:
And that's just the base CCM code. Patients who require additional time (CPT 99439) generate additional reimbursement. Patients who qualify for Complex CCM (CPT 99487, $144.29/month) generate substantially more. Layer RPM on top for monitoring-eligible patients and the per-patient revenue stack increases further.
Bipartisan healthcare legislation in this Congress moves on its own schedule. The CCM Improvement Act has been introduced in prior sessions and didn't make it across the finish line. What's different in 2026: a larger coalition of supporting organizations, more visible patient advocacy attention, and a documented gap between Medicare's policy goals (increased care coordination, reduced hospitalizations) and the actual enrollment numbers.
Realistic timelines: committee hearings through summer 2026, potential floor vote in late 2026 or early 2027, implementation typically 6–12 months after enactment. Practices that build CCM infrastructure now will have 12–18 months to optimize their enrollment workflow before the cost-sharing barrier is potentially removed.
Will this affect commercial CCM coverage?
No. The bill specifically addresses Medicare patient cost-sharing. Commercial payers set their own cost-sharing structures and aren't affected by this legislation.
Does the legislation change the CCM billing codes or rates?
No. The 2026 CCM rates (99490: $66.13, 99439: $50.44, 99487: $144.29, 99489: $78.16) and code requirements remain unchanged. The bill only eliminates the 20% patient coinsurance — practices still bill and are reimbursed at full rates.
What happens if a patient already paid CCM coinsurance and the bill passes?
The bill would apply prospectively from its effective date. Patients who paid coinsurance before that date would not be retroactively reimbursed.
If we don't bill CCM today, can we still benefit from this change?
Yes — but you'll need infrastructure in place before you can enroll patients efficiently. CCM requires documented patient consent, a comprehensive care plan addressing all chronic conditions, designated clinical staff for monthly coordination time, and audit-ready documentation. Building that workflow takes time. Practices that wait until the bill passes will be 6+ months behind practices that are billing today.
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