2025 CPT code 99439
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Care Management Services Evaluation and Management Feed
Each additional 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional for chronic care management, per calendar month.
Modifiers may be applicable depending on the specific circumstances of service. Consult the most current CPT guidelines for modifier application rules.
Medical necessity is established by the presence of at least two chronic conditions expected to last at least 12 months, placing the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.The services must be medically necessary and must meet the time requirements.
Clinical staff, under the direction of a physician or other qualified healthcare professional, are responsible for providing chronic care management services. The physician or other qualified healthcare professional oversees the plan of care and is responsible for the overall management.
In simple words: This code is for extra time spent by healthcare staff, directed by a doctor, helping manage a patient's ongoing health problems. It's only used if the staff already spent 20 minutes (as billed with code 99490) and now need to spend another 20 minutes or more. This can happen up to twice in a month.
This CPT code reports each additional 20 minutes of clinical staff time spent on chronic care management activities beyond the initial 20 minutes (99490) during a calendar month.It is used in conjunction with 99490 and should only be reported up to a maximum of two times per calendar month, for a total of 60 minutes of clinical staff time.The services must be directed by a physician or other qualified healthcare professional, and the patient must have at least two chronic conditions.
Example 1: A 65-year-old patient with type 2 diabetes and hypertension requires 40 minutes of clinical staff time for medication reconciliation, health education, and care coordination in a given month.Code 99490 is billed for the first 20 minutes, and code 99439 is billed for the additional 20 minutes., A 70-year-old patient with congestive heart failure, COPD, and anxiety requires 60 minutes of clinical staff time during a calendar month for monitoring, education, and coordination of care. Code 99490 and two units of 99439 are billed., An 80-year-old patient with three chronic conditions, including diabetes, hypertension, and renal insufficiency, needs 25 minutes of clinical staff time for care management.Only code 99490 is billed because the time does not reach the 40-minute threshold required for adding 99439.
Documentation should include the patient's chronic conditions, the care plan, the minutes spent on care management activities for each staff member, evidence of coordination with other healthcare professionals (as appropriate), and the patient’s risk assessment.
** The time spent on chronic care management services should not be included in the time reported for other services such as Evaluation & Management services.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: The RVUs for this code will vary based on geographic location and other factors.Consult the relevant fee schedule for specific payment rates.
- Global Days: Not applicable. This code is for time spent during a calendar month, not tied to a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Consult the CMS National Physician Fee Schedule or other relevant payer fee schedule for historical fee data.
- Specialties:Family Medicine, Internal Medicine, Cardiology, Endocrinology, Geriatrics, and other specialties managing patients with multiple chronic conditions.
- Place of Service:Office, Home, Assisted Living Facility, other settings where chronic care management is provided.