Part of Chronic Care Management
CPT 99491: Non-complex CCM, first 30 minutes of physician/QHP time
First 30 minutes per calendar month of non-complex chronic care management personally furnished by a physician or other qualified health professional.
Time threshold & code combinations
First 30 minutes of physician/QHP time per calendar month.
- 99437 is the add-on for each additional 30 minutes and cannot be billed without 99491 first in the same month
- Mutually exclusive with 99490 for the same month, choose physician-time billing or clinical-staff-time billing, not both, for the same minutes
Who can bill
- Physicians
- Qualified health professionals (e.g., nurse practitioners, physician assistants)
Eligibility & billing requirements
- Two or more chronic conditions expected to last at least 12 months or until death, with significant risk as described in the program overview
- Documented patient consent
- Time personally spent by the billing physician/QHP, not delegated clinical staff time
- A comprehensive care plan established, implemented, revised, or monitored during the month
When to use it
Physician personally manages care plan updates
A physician spends 30 minutes personally reviewing labs and adjusting medications for a patient with heart failure and CKD, without delegating the work to staff.
Billing: 99491
Documentation checklist
- Time log attributing minutes to the physician/QHP personally
- Care plan entry or revision for the month
Common billing mistakes
- Logging clinical staff time under 99491 instead of using 99490
- Billing without a documented care plan review for the month