Category
Chronic Care Management Services
CODE TYPE
Timed based code
Billed for first 30 Minutes
ADD-ON CODE
99437
CHRONIC CARE MANAGEMENT
CPT 99491 is billed to the patient receiving non-complex CCM service, for first 30 minutes that are provided personally by a physician or other qualified health care professional, multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. These chronic conditions place the patient at risk of death, acute exacerbation/decompensation and functional decline. Chronic care management services include the establishment, implementation, revision, and monitoring of a comprehensive patient care plan.
CODING CRITERIA
For CPT 99491, the following criteria should be met:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- For this CCM service minimum of 30 minutes provided personally by a physician or other qualified health care professional is required
- Chronic conditions that lead to the risk of death, acute exacerbation/decompensation, or functional decline of patient
- Comprehensive care plan established, implemented, revised, or monitored
BILLING CRITERIA
Providers cannot bill more than one CCM claim for a patient per calendar month i.e. 30 days
ADD ON CODE:
In case of service provided for more than the first 30 minutes, CPT code 99491 requires add-on code 99437 for each additional 30 minutes by a physician or other qualified health care professional
