2025 CPT code 99437
(Active) Effective Date: N/A Evaluation and Management - Care Management Services Feed
Chronic care management services, each additional 30 minutes by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure).
Modifiers may be applicable depending on the circumstances of the service. Refer to payer guidelines for specific modifier usage.
Medical necessity must be established for the services provided. The patient's chronic conditions must pose a significant risk to their health, and the care management services must be necessary to address those risks.
A physician or other qualified healthcare professional spends an additional 30 minutes in a calendar month, beyond the first 30 minutes, implementing, establishing, revising, or monitoring the comprehensive care plan for a patient with two or more chronic conditions expected to last at least 12 months or until end of life. These chronic conditions, which may include diabetes and advanced cardiovascular conditions like congestive heart failure, place the patient at significant risk for death, acute exacerbation, acute decompensation, or decline in function. The care plan should be specific to the individual with goals for each condition.
In simple words: A physician or other qualified healthcare professional personally performs management and care plan services for a patient with two or more chronic conditions, expected to last at least one year or until the patient’s death. The conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. Use this code for each additional 30 minutes of physician or other qualified healthcare professional time per calendar month, beyond the first 30 minutes.
Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored; each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure).
Example 1: A patient with type 2 diabetes and hypertension requires ongoing care management. The physician spends an initial 30 minutes (99491) developing the care plan, then an additional 30 minutes (99437) adjusting medications and coordinating care with the patient's ophthalmologist., A patient with congestive heart failure and chronic kidney disease requires frequent monitoring and adjustments to their medication regimen. The physician spends the initial 30 minutes (99491) reviewing lab results and coordinating with home health, then spends an additional 30 minutes (99437) discussing medication changes and lifestyle modifications with the patient and their family., A patient with COPD and anxiety requires assistance managing their conditions. After the initial 30 minutes of care plan development (99491), the physician spends an additional 30 minutes (99437) educating the patient on proper inhaler technique and coordinating mental health services.
Documentation should include the total time spent by the physician/QHP on care management activities, the chronic conditions being managed, the complexity of the conditions, the patient's risk factors, the care plan elements, and any communication or coordination with other healthcare professionals.
** This code is an add-on code and requires 99491 to be billed.The total time spent on chronic care management should be documented accurately, even if it exceeds the time blocks defined by these codes. Payer guidelines should be consulted for reimbursement policies.
- Payment Status: Active
- Specialties:Primary care, internal medicine, family medicine, geriatrics, and other specialties managing chronic conditions.
- Place of Service:Office, Home, Assisted Living Facility, Nursing Facility, and other places where chronic care management services are provided.