CPT 99491 is chronic care management billed on the practitioner’s own time: the first 30 minutes each calendar month that a physician or other qualified health care professional personally spends managing a patient with multiple chronic conditions. In 2026 it pays $89.18 nationally in the non facility setting, before geographic adjustment. The add on, CPT 99437, covers each additional 30 minutes at $63.13.
The one rule that defines this code
Only the billing practitioner’s personal time counts. Clinical staff minutes, which are the entire basis of CPT 99490, count for nothing here. CMS is explicit that this service cannot be furnished incident to or delegated: the practitioner does the work personally. That is why it pays more than 99490 ($89.18 versus $66.13) for a longer time requirement (30 minutes versus 20).
99491 versus 99490: picking the right lane
The two codes describe the same program with different labor. If your care coordinators do the monthly work under the practitioner’s general supervision, 99490 and 99439 are your codes, and they scale because staff time is cheaper than practitioner time. If the practitioner personally carries the monthly management, often the case in very small practices without dedicated staff, 99491 and 99437 pay better for that reality. You cannot mix them: Medicare bars billing 99491 or 99437 in the same calendar month as 99490, 99439, 99487, or 99489 for the same patient. Most practices building a scalable program land on the staff codes; 99491 fits the solo physician doing it personally until staffing catches up.
Everything else CCM requires still applies
Patient eligibility is identical: two or more chronic conditions expected to last at least 12 months or until death, with significant risk of death, acute exacerbation or decompensation, or functional decline. The electronic comprehensive care plan, documented consent, 24/7 access, certified EHR data, initiating visit for new patients, and the one practitioner per month rule all apply. The medically unlikely edits allow 1 unit of 99491 and up to 2 units of 99437 per date of service.
Practice Management Consultancy helps practices decide which CCM lane fits their staffing reality and build the program around it. Start with a care management assessment, or see the full CPT 99490 requirements.
Sources
- CMS, Chronic Care Management Services, MLN909188 (June 2025)
- CMS, CCM Billing FAQ (updated 8/16/2022)
- CMS Physician Fee Schedule Relative Value File, July 2026 release (rates shown are 2026 national non facility amounts, standard conversion factor, before locality adjustment)
- CMS NCCI Medically Unlikely Edits, practitioner table effective 07/01/2026
