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CPT 99491
Description, Billing Rules, and Use Cases

CPT 99491 is used to bill for Chronic Care Management (CCM) services that are personally delivered by a physician or other qualified healthcare professional (QHP).

 

This code covers the first 30 minutes of non-face-to-face care management provided in a calendar month for patients with two or more chronic conditions.

 

Unlike other CCM codes that rely on clinical staff time, 99491 is billed only when the provider themselves delivers the service.

What is CPT Code 99491?

CPT 99491 is used when a physician or other qualified healthcare professional personally provides at least 30 minutes of Chronic Care Management (CCM) services during a calendar month. These services support patients with two or more chronic conditions that are expected to last at least 12 months or until death, and which place the patient at significant risk of clinical deterioration.

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CPT 99491 should be used when:

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  • The patient has 2+ chronic conditions with long-term impact on health

  • A comprehensive care plan is created, maintained, or revised

  • The provider personally delivers at least 30 minutes of care management

  • Services occur outside of face-to-face E/M visits

  • The time does not overlap with services reported under staff-delivered codes (e.g., 99490 or 99439)
     

For each additional 30 minutes of provider time in the same month, use add-on code 99437.

CPT 99491 Billing Requirements and Eligibility

CPT 99491 is used to bill for Chronic Care Management (CCM) services when those services are delivered personally by a physician or other qualified healthcare professional (QHP). The following requirements must be met for reimbursement.

Patient Eligibility Criteria

  • The patient must have two or more chronic conditions which:

    • Are expected to last at least 12 months, or until the patient’s death

    • Place the patient at significant risk of death, acute exacerbation, decompensation, 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 or other QHP (e.g., NP or PA)

  • The provider must personally deliver at least 30 minutes of care management services

  • Services may not be delegated to or performed by clinical staff (see table below for details)

Service Requirements

  • A minimum of 30 minutes of direct non-face-to-face provider time must be documented within a calendar month

  • Time must be distinct from other reported services, such as E/M visits or transitional care

  • CPT 99491 may not be billed in the same month as:

    • 99490 (clinical staff CCM)

    • 99439 (add-on to 99490)

    • 99487/99489 (complex CCM)

    • 99484 or 99492–99494 (behavioral health integration)

    • 99495/99496 (transitional care)

CPT 99491 Billing Documentation Checklist

To compliantly bill CPT 99491, your documentation must clearly show:

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  • A minimum of 30 minutes of non-face-to-face care management personally performed by a physician or other qualified healthcare professional (QHP).

    • Include specific dates, tasks performed, and total time recorded within the calendar month.

  • A comprehensive care plan that was:

    • Established, implemented, revised, or monitored during the billing period

    • Tailored to the patient’s chronic conditions and overall health needs

    • Documented in the medical record and, when appropriate, shared with the patient and/or caregiver

  • Confirmation that the services were performed personally by the provider and not delegated to clinical staff.

    • Clinical staff time may not be included in the 99491 time threshold.

  • Notes reflecting care coordination or management, such as:

    • Medication reconciliation

    • Review of labs or tests (outside of E/M)

    • Communication with other providers

    • Patient education or adherence tracking

  • A statement verifying that billed time is not duplicated or overlapped with:

    • CPT 99490 or 99439

    • CPT 99487/99489

    • Behavioral health integration codes (99484, 99492–99494)

    • Transitional care codes (99495–99496)

    • Any other time-based codes reported that month

CPT 99491 Time Thresholds and Code Combinations

CPT 99491 is used when a physician or other qualified healthcare professional personally provides at least 30 minutes of non-face-to-face Chronic Care Management services in a calendar month. Time-based billing is cumulative and must be documented carefully to support reimbursement.

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Use the table below to determine the appropriate code(s) to report based on who delivered the care and how much time was spent:

Time-based billing table for CPT 99491. Compares provider-delivered care (99491 and 99437) to staff-delivered care (99490 and 99439) based on monthly time thresholds.

Important to Note:

You may only bill one CCM path per patient per month — either clinical staff–based (99490/99439) or provider-performed (99491/99437), not both. Time cannot be split or double-counted between these pathways.

When to Use CPT 99491:
Common Scenarios and Use Cases

CPT 99491 should be used when a physician or other qualified healthcare professional (QHP) personally provides at least 30 minutes of Chronic Care Management (CCM) services in a given calendar month. These services may include medication management, care coordination, patient education, and proactive planning — but must be directly delivered by the provider.

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Below are common use cases for when to bill CPT 99491:

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  • Medication Management for CHF and CKD
    A physician spends time:

    • Reviewing labs and medication reconciliation

    • Coordinating changes with cardiology and nephrology

    • Counseling the patient on fluid and dietary restrictions
      Total qualifying time: 35 minutes
      Billing: 99491

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  • Proactive Planning for High-Risk Diabetes
    A nurse practitioner delivers:

    • Remote goal-setting for A1C reduction

    • Education on insulin titration and dietary changes

    • Direct patient communication and documentation updates
      Total qualifying time: 70 minutes
      Billing: 99491 + 99437

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  • Assisted Living Care Plan Review
    A provider works with facility staff and family to:

    • Review cognitive status, fall risk, and behavior changes

    • Update care plan and medication regimen

    • Coordinate with specialists for dementia and mobility therapy
      Total qualifying time: 90+ minutes
      Billing: 99491 + 99437 ×2

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Common CPT 99491 Billing Mistakes
(and How to Avoid Them)

  • ❌ Billing 99491 Without 30 Minutes of Provider Time
    You must document at least 30 minutes of non-face-to-face care delivered personally by a physician or QHP. Anything less is not billable, even if clinical staff contributed time.
     

  • ❌ Using 99491 for Clinical Staff Time.
    This code is strictly reserved for provider time. Services delivered by nurses, MAs, or care coordinators must be billed under 99490 or 99439 — not 99491.
     

  • ❌ Billing 99491 and 99490 Together
    You may not bill CPT 99491 in the same calendar month as 99490 or 99439. Choose one CCM billing path per patient per month — provider-led or staff-led — but not both.
     

  • ❌ Overlapping Time with Other Codes
    Time may not be double-counted toward multiple codes. ​The time reported for 99491 must be distinct from time spent on:

  • ❌ Insufficient Documentation
    Your notes must clearly show:

    • That care was provided directly by the physician or QHP

    • The specific tasks completed (e.g., medication review, patient follow-up)

    • The date(s) and total minutes of service

    • That services were non-face-to-face and delivered outside of an E/M visit

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