2025 CPT code 99491
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Chronic Care Management Evaluation and Management > Care Management Services Feed
Chronic care management services; first 30 minutes of physician/qualified healthcare professional time per calendar month.
Modifiers may apply depending on the specific circumstances of the service. Consult the AMA CPT manual for details.
Medical necessity is established by the presence of two or more chronic conditions expected to last at least 12 months or until death, placing the patient at significant risk. The services are necessary to coordinate care, reduce hospitalizations, improve patient engagement, and decrease care fragmentation.
The physician or other qualified healthcare professional is responsible for establishing, implementing, revising, and monitoring the comprehensive care plan, communicating with other healthcare professionals, educating the patient and/or caregiver, and collecting and reviewing health data.
In simple words: This code covers a doctor or other qualified healthcare provider spending at least 30 minutes each month managing the care plan for a patient with two or more long-term health problems that put them at high risk. This includes planning, monitoring, and communicating with the patient and other healthcare providers.
This CPT code reports chronic care management services personally provided by a physician or other qualified healthcare professional.The service must include at least 30 minutes of their time per calendar month, involving establishing, implementing, revising, or monitoring a comprehensive care plan for a patient with two or more chronic conditions expected to last at least 12 months or until death. These conditions must pose a significant risk of death, acute exacerbation/decompensation, or functional decline.The 30 minutes does not include time spent on the same day as a face-to-face E/M encounter.
Example 1: A 65-year-old patient with type 2 diabetes and hypertension requires comprehensive care plan management, including medication adjustments, lifestyle counseling, and coordination with a diabetes educator. The physician spends 45 minutes reviewing labs, adjusting medications, and communicating with the diabetes educator. Code 99491 and 99437 are reported., A 72-year-old patient with congestive heart failure and chronic obstructive pulmonary disease needs regular monitoring and adjustment of medications. The physician spends 35 minutes reviewing the patient's condition, conducting a telehealth visit, and communicating with the patient's cardiologist and pulmonologist. Code 99491 is reported., An 80-year-old patient with dementia and osteoarthritis requires coordinated care involving a home health nurse, physical therapist, and social worker.The physician spends 60 minutes reviewing the care plan, communicating with the home health team, and ensuring appropriate services are delivered. Code 99491 and 99437 are reported.
Comprehensive care plan documented in certified EHR, including patient's goals and treatment plan for each chronic condition.Documentation of time spent in care management activities, communication with other providers, patient/caregiver education, and review of relevant data (labs, imaging).Evidence of two or more chronic conditions, lasting at least 12 months, and placing the patient at significant risk.
** This code is specifically for time spent personally by the physician or other qualified health professional.Time spent by clinical staff is reported using separate codes (99490 and 99439).
- Revenue Code: M5D (Specialist - Other)
- RVU: This information varies by payer and location. Consult your specific payer's fee schedule for current RVU values and reimbursement rates.
- Global Days : Not applicable.This is a monthly service.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule : Fee schedules vary by payer and location. Historical fee data can be found in archival payer fee schedules.
- Specialties:Family Medicine, Internal Medicine, Cardiology, Geriatrics, Endocrinology, Pulmonary Medicine
- Place of Service:Office, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home