99491
Chronic care management — first 30 minutes of physician or QHP time
CCM delivered personally by the physician or QHP rather than by clinical staff.
2026 national amount
—
Billing cadence
Per calendar month
Code family
CCM
- The same CCM eligibility applies — two or more chronic conditions, care plan, consent
- At least 30 minutes of the physician's or QHP's own time, not clinical staff time
- Add 99437 for each further 30 minutes of physician or QHP time
- Not billed in the same month as 99490 for the same patient
Who can bill it
Physician or qualified health professional personally.
Other CCM codes.
- 99490The base monthly CCM code for patients with two or more chronic conditions
- 99439The add-on for each further 20 minutes of CCM clinical staff time
- 99437The add-on for each further 30 minutes of the physician's own CCM time
- 99487The complex-CCM base code, for patients needing moderate or high complexity decision-making
- 99489The add-on for each further 30 minutes of complex CCM clinical staff time
A code is a claim. Documentation is the proof.
Most denied monitoring claims fail on documented time, consent, or the interactive communication — not on choosing the wrong code. We build the workflow so the record is made as the care happens.
- 99445 (2–15 days) and 99454 (16–30 days) cannot be billed in the same 30-day period
- 98984/98976 and 98985/98977 follow the same rule
- 99470 (10 min) and 99457 (20 min) cannot be billed in the same month
- 98979 (10 min) and 98980 (20 min) follow the same rule
- Add-on codes (99458/98981) only pair with the 20-minute base codes
- RPM and RTM cannot be billed for the same patient in the same month
- All treatment management codes require at least one live interactive communication per month
- 99454 requires automatic data transmission from the device
- Minimum 2 days of data transmission for all device supply codes
Amounts shown are 2026 national figures and are an estimate, not a quote — actual payment varies by locality, payer, and documented time. This reference is a summary for planning, not billing advice or a substitute for the current fee schedule and payer policy.
Billing 99491 correctly is the whole job.
We run the CCM programme and the revenue cycle behind it — documented time, consent, and claims handled as part of the care rather than after it.