CPT 99437 is an add-on billing code used for each additional 30 minutes of Chronic Care Management provided personally by a physician or qualified healthcare professional. It must be reported in conjunction with CPT 99491.

When can you bill CPT 99437?

You can bill CPT 99437 when total provider time exceeds 60 minutes in a calendar month, and CPT 99491 has already been billed for the first 30 minutes. One unit of 99437 is added for each additional 30-minute block.

Can CPT 99437 be billed on its own?

No. CPT 99437 is an add-on code and may only be billed in the same calendar month and claim as CPT 99491. It cannot be used as a standalone code.

What documentation is required for CPT 99437?

You must document the total time personally delivered by the provider beyond the initial 30 minutes, the services performed, and that the time was distinct from other billed codes such as 99490 or 99487.

Can you bill CPT 99437 with 99490 or 99487?

No. CPT 99437 may not be billed in the same calendar month as CPT 99490, 99439, 99487, or 99489. Providers must choose one CCM billing path per patient per month.

CPT 99437
Description, Billing Rules, and Use Cases

CPT 99437 is an add-on billing code used to report each additional 30 minutes of Chronic Care Management (CCM) services personally provided by a physician or other qualified healthcare professional (QHP).

This code is used in conjunction with CPT 99491, which covers the first 30 minutes of provider-delivered time per calendar month.

CPT 99437 may be billed multiple times when care management services exceed 60, 90, or 120+ minutes, provided that each time block is separately documented and personally delivered by the provider.

What is CPT Code 99437?

CPT 99437 is used to report each additional 30-minute block of Chronic Care Management services provided by a physician or QHP, after the initial 30 minutes have been reported with CPT 99491. This code is billed in addition to 99491 when more than 30 minutes of direct, non-face-to-face care is delivered in a calendar month.

Use CPT 99437 when:

The patient has two or more chronic conditions expected to last at least 12 months or for the rest of their life
The patient’s conditions place them at significant risk of death, exacerbation, or functional decline
A comprehensive care plan has been created and is actively monitored or revised
The physician or QHP has already provided 30 minutes of care (billed under 99491)
An additional 30-minute block is completed and appropriately documented

CPT 99437 cannot be billed on its own and must be reported in conjunction with CPT 99491. It may not be billed in the same calendar month as 99490, 99439, 99487, 99489, or TCM/BHI codes.

CPT 99437 Billing Requirements and Eligibility

CPT 99437 is an add-on code used to report each additional 30-minute block of Chronic Care Management services personally performed by a physician or other qualified healthcare professional (QHP). It can only be billed in conjunction with CPT 99491.

The following criteria must be met for proper use and reimbursement:

Patient Eligibility Criteria

The patient must have two or more chronic conditions which:
- Are expected to last at least 12 months, or for the remainder of the patient's life
- Place the patient at significant risk of death, exacerbation, or functional decline
A comprehensive care plan must be:
- Established, implemented, revised, or monitored during the billing period
- The plan must address medical, psychosocial, and functional needs
- The plan must be documented in the medical record and shared with the patient or caregiver as appropriate

Provider Requirements

The billing provider must be a physician, nurse practitioner, or physician assistant
The provider must have already reported CPT 99491 for the first 30 minutes of care that month
99437 cannot be billed on its own — it is used only for additional 30-minute increments beyond the initial time

Service Requirements

A minimum of 60 minutes of total provider time is required to bill 99491 + 99437
Additional 30-minute blocks may be reported using 99437 ×2, ×3, etc. if time continues to meet the threshold
Time must be:
- Non-face-to-face
- Personally delivered by the provider (not staff)
- Distinct from other time-based codes, such as:
  - 99490 or 99439 (staff CCM)
  - 99487 or 99489 (complex CCM)
  - 99495–99496 (transitional care)
  - 99484, 99492–99494 (behavioral health integration)

CPT 99437 Billing Documentation Checklist

To ensure clean and compliant billing for CPT 99437, documentation should include the following:

A clear record that CPT 99491 was already reported for the calendar month
- CPT 99437 cannot be billed as a standalone code
A total of 60 or more minutes of personally performed, non-face-to-face Chronic Care Management services by a physician or QHP
- Time must be cumulative and meet the 30-minute threshold for each unit of 99437
A detailed summary of services performed during the additional time blocks, such as:
- Reviewing test results not part of an E/M service
- Updating care plans
- Coordinating with other providers or care agencies
- Patient or caregiver education and communication
Documentation that the services were:
- Personally delivered by the billing provider
- Not delegated to clinical staff
- Distinct from time billed under any other code
A complete care plan present in the medical record, including goals, risk factors, interventions, and monitoring approach
A note confirming that no overlapping codes were billed in the same month, including:
- CPT 99490, 99439 (staff-based CCM)
- CPT 99487, 99489 (complex CCM)
- Behavioral health integration or TCM codes (99484, 99495, 99496, etc.)

CPT 99437 Time Thresholds and Code Combinations

CPT 99437 is used to report each additional 30 minutes of Chronic Care Management (CCM) services personally provided by a physician or other qualified healthcare professional (QHP), beyond the first 30 minutes reported with CPT 99491. This add-on code is not billable on its own, and should only be used once the 60-minute threshold of cumulative provider time has been met.

Use the table below to determine which code(s) to report based on the total amount of provider time delivered in a calendar month:

Time-based billing chart for CPT 99437 showing total provider time required to report each unit. CPT 99491 is billed for the first 30 minutes; CPT 99437 is used for each additional 30-minute block of personally delivered CCM services.

Important to Note:

CPT 99437 is an add-on code and must always be billed with CPT 99491.

It may be billed multiple times when each additional 30-minute threshold is met, but may not be used:

On its own (without 99491)
In the same calendar month as staff-based CCM codes (99490, 99439), complex CCM (99487, 99489), or transitional/behavioral codes (99495, 99496, 99484, etc.)
All billed time must be distinct, personally delivered by the provider, and clearly documented.

When to Use CPT 99437:
Common Scenarios and Use Cases

CPT 99437 should be used when a physician or qualified healthcare professional provides more than 30 minutes of Chronic Care Management (CCM) services in a calendar month. It is billed in addition to CPT 99491, which covers the first 30 minutes. Each 99437 unit represents an additional 30-minute block of provider-delivered care.

Here are examples of how CPT 99437 is used in practice:

Expanded Care for Heart Failure + Diabetes
A physician spends extended time:
- Reviewing cardiology and endocrinology reports
- Coordinating medication changes across specialties
- Following up on patient education goals and adherence
  Total provider time: 70 minutes
  Billing: 99491 + 99437

Repeated Interventions for Complex COPD Case
A nurse practitioner delivers multi-week support that includes:
- Chronic symptom tracking
- Frequent direct communication with home health
- Care plan revisions based on evolving test results
  Total provider time: 95 minutes
  Billing: 99491 + 99437 x2

Assisted Living Patient With Cognitive Decline
A provider :
- Coordinates multidisciplinary meetings with family and facility staff
- Adjusts medication strategy
- Documents multiple changes to the care plan throughout the month
  Total provider time: 125 minutes
  Billing: 99491 + 99437 ×3

Common CPT 99437 Billing Mistakes
(and How to Avoid Them)

❌ Billing CPT 99437 Without 99491
CPT 99437 is an add-on code only. It must be billed in the same claim and calendar month as CPT 99491. It cannot be used on its own.
❌ Reporting Less Than 60 Minutes of Provider Time
The first 30 minutes are covered by CPT 99491. You may only bill 99437 when at least 60 minutes of total provider time is documented. Additional units of 99437 require 90, 120, or 150+ minutes, respectively.
❌ Billing 99491 and 99490 Together
Only time personally delivered by a physician or qualified healthcare professional counts toward 99437. Clinical staff time should be billed under 99490 or 99439 — not 99437.
❌ Billing With Overlapping Codes
Do not bill 99437 in the same month as:
- CPT 99490 or 99439 (clinical staff CCM)
- CPT 99487 or 99489 (complex CCM)
- Transitional care codes (99495–99496)
- Behavioral health integration (99484, 99492–99494)
  Each of these codes requires distinct, non-overlapping time.
❌ Inadequate Documentation of Additional Time
You must document:
- The exact additional time spent beyond the initial 30 minutes
- The services provided (e.g., coordination, planning, communication)
- That the services were personally delivered by the billing provider
  Missing time logs or vague notes can trigger denials or post-payment review.

CPT 99437 Description, Billing Rules, and Use Cases