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CPT 99491: Chronic Care Management, Physician Personal 30 Minutes

CPT code 99491 designates a physician or other qualified healthcare professional personally providing chronic care management and care plan services for patients with two or more chronic conditions that are expected to last at least one year or until death and place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. It applies to the first 30 minutes of the professional’s time per calendar month and is intended to capture direct clinician time spent managing complex chronic patients.

This analysis covers national implications for major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of service definitions, typical sites of service, payer coverage patterns, and common billing considerations. The publication summarizes benchmarking approaches, notable policy clarifications, and clinical context for appropriate use, including how CPT code 99491 fits within broader chronic care management programs and time-based billing structures. Data not provided in the input are noted as unavailable in the relevant sections. The content is designed to inform coding professionals, practice managers, and policy analysts about the clinical meaning, administrative use, and payer landscape for CPT code 99491 at a national level.

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Billing Code Overview

CPT code 99491 describes a physician or other qualified healthcare professional personally performing care management and care plan services for a patient with two or more chronic conditions expected to last at least one year or until the patient’s death. The conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. Use of this code applies to the first 30 minutes of the professional’s time per calendar month.

Service type: Chronic care management and care plan development delivered personally by a physician or other qualified healthcare professional.
Typical site of service: Outpatient ambulatory settings or other non-acute care settings where longitudinal chronic care management is provided, including office visits, clinic-based care, and other outpatient management encounters.

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CPT 99491: Chronic Care Management, Physician Personal 30 Minutes

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Get alerted when payer policies referencing 99491 are released or updated.

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Billing Code Overview

Service type: Chronic care management and care plan development delivered personally by a physician or other qualified healthcare professional.
Typical site of service: Outpatient ambulatory settings or other non-acute care settings where longitudinal chronic care management is provided, including office visits, clinic-based care, and other outpatient management encounters.

Clinical & Coding Specifications

Clinical Context

A 78-year-old patient with a history of chronic heart failure with reduced ejection fraction, type 2 diabetes mellitus, and chronic kidney disease presents for monthly chronic care management. The physician (or other qualified healthcare professional) personally performs a comprehensive review of the patient’s condition status, medications, recent hospitalizations, symptom changes, laboratory trends, and care goals. The clinician spends the first 30 minutes in the calendar month directly managing and coordinating care, updating the problem list, reconciling medications, adjusting the care plan, and communicating with caregivers and other clinicians as needed. Typical workflow includes pre-visit chart review, synchronous or asynchronous patient and caregiver communication (phone or secure message), documentation of time-based services, and creation of a written or electronic care plan outlining medical problems, goals, self-management tasks, and follow-up. The typical site of service is an outpatient clinic, physician office, or other ambulatory setting where a physician or qualified healthcare professional provides direct chronic condition management. Use of 99491 applies to the first 30 minutes of provider time in a calendar month for a patient with two or more chronic conditions expected to last at least one year or until death, placing the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	When a distinct E/M visit is performed the same day as `99491` and meets documentation criteria
`22`	Increased procedural services	When the complexity or time significantly exceeds typical service and payer allows use for reporting increased work
`24`	Unrelated E/M service during postoperative period	When an unrelated E/M occurs during the global postoperative period separate from chronic care management
`59`	Distinct procedural service	When another service or procedure is distinct and separate from the chronic care management service
`52`	Reduced services	When the service provided is partially reduced or not completed as described by full code definition
`53`	Discontinued procedure	When the chronic care management encounter is discontinued due to extenuating circumstances
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When `99491` is delivered via synchronous telemedicine with required documentation of modality
`95`	(Note: `95` appears once in the list above; use as CMS telemedicine modifier where accepted)	When telehealth policy allows modifier `95` for professional services
`62`	Two surgeons	When two surgeons share responsibility for a complex shared service (rarely applicable)
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a complication	When an unexpected procedure-related complication requires return to OR (rare for this code)
`80`	Assistant surgeon	When an assistant surgeon provided services (rarely applicable to chronic care management)

Taxonomy Code	Specialty	Notes
207RC0000X	Internal Medicine	Primary physicians frequently perform chronic care management under `99491`
207RH0000X	Family Medicine	Family physicians commonly provide longitudinal management for multiple chronic conditions
207RM1200X	Geriatric Medicine	Geriatricians manage complex older adults with multimorbidity and functional decline
207RH0002X	Nurse Practitioner	NPs may provide chronic care management services when appropriately credentialed and payer policy allows
208000000X	Physician Assistant	PAs participate in chronic care management under supervising physician or payer rules

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.22`	Chronic systolic (congestive) heart failure	Heart failure is a common chronic condition requiring monthly management, medication titration, and monitoring for decompensation
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes commonly coexists with other chronic conditions and requires ongoing management and care planning
`N18.4`	Chronic kidney disease, stage 4 (severe)	Advanced CKD increases risk of decompensation and necessitates careful monthly coordination of care and medication adjustments
`J44.9`	Chronic obstructive pulmonary disease, unspecified	COPD contributes to risk of acute exacerbation and functional decline, fitting `99491` patient criteria
`F03.90`	Unspecified dementia without behavioral disturbance	Cognitive impairment increases care complexity and need for care coordination and caregiver communication
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Chronic ischemic heart disease commonly coexists and contributes to overall morbidity requiring chronic care management
`M16.11`	Unilateral primary osteoarthritis, right hip	Significant musculoskeletal disease can cause functional decline and requires ongoing management planning

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Often billed for non-face-to-face clinical staff time; `99491` is the provider-performed first 30 minutes and may be used instead when physician/qualified professional time meets criteria
`99487`	Complex chronic care management services, first hour of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used for complex CCM involving at least 60 minutes of clinical staff time; complements `99491` when additional complex care management is provided by staff
`99489`	Complex chronic care management services, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used to report additional time beyond the initial complex CCM; workflow may include both provider time (`99491`) and staff time codes
`99495`	Transitional care management services with moderate medical decision complexity (face-to-face within 14 days)	May be billed in the post-discharge period when a transition of care occurs; differs from monthly chronic care management but commonly coordinates with CCM workflows
`99496`	Transitional care management services with high medical decision complexity (face-to-face within 7 days)	Similar to `99495` for higher complexity transitions; may be part of the overall care plan coordination that complements `99491`

CPT 99487: Complex Chronic Care Management, First 60 Minutes

CPT-99489-PROVIDER-DIRECTED-CLINICAL-STAFF-CARE-COORDINATION-COMPLEX-CHRONIC-CONDITIONS

CPT 99489: Provider-Directed Clinical Staff Care Coordination for Complex Chronic Conditions

CPT-99490-CHRONIC-CARE-MANAGEMENT-PROVIDER-DIRECTED-20-MIN

CPT 99490: Provider-Directed Chronic Care Management, First 20 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	When a distinct E/M visit is performed the same day as `99491` and meets documentation criteria
`22`	Increased procedural services	When the complexity or time significantly exceeds typical service and payer allows use for reporting increased work
`24`	Unrelated E/M service during postoperative period	When an unrelated E/M occurs during the global postoperative period separate from chronic care management
`59`	Distinct procedural service	When another service or procedure is distinct and separate from the chronic care management service
`52`	Reduced services	When the service provided is partially reduced or not completed as described by full code definition
`53`	Discontinued procedure	When the chronic care management encounter is discontinued due to extenuating circumstances
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When `99491` is delivered via synchronous telemedicine with required documentation of modality
`95`	(Note: `95` appears once in the list above; use as CMS telemedicine modifier where accepted)	When telehealth policy allows modifier `95` for professional services
`62`	Two surgeons	When two surgeons share responsibility for a complex shared service (rarely applicable)
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a complication	When an unexpected procedure-related complication requires return to OR (rare for this code)
`80`	Assistant surgeon	When an assistant surgeon provided services (rarely applicable to chronic care management)

Taxonomy Code	Specialty	Notes
207RC0000X	Internal Medicine	Primary physicians frequently perform chronic care management under `99491`
207RH0000X	Family Medicine	Family physicians commonly provide longitudinal management for multiple chronic conditions
207RM1200X	Geriatric Medicine	Geriatricians manage complex older adults with multimorbidity and functional decline
207RH0002X	Nurse Practitioner	NPs may provide chronic care management services when appropriately credentialed and payer policy allows
208000000X	Physician Assistant	PAs participate in chronic care management under supervising physician or payer rules

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.22`	Chronic systolic (congestive) heart failure	Heart failure is a common chronic condition requiring monthly management, medication titration, and monitoring for decompensation
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes commonly coexists with other chronic conditions and requires ongoing management and care planning
`N18.4`	Chronic kidney disease, stage 4 (severe)	Advanced CKD increases risk of decompensation and necessitates careful monthly coordination of care and medication adjustments
`J44.9`	Chronic obstructive pulmonary disease, unspecified	COPD contributes to risk of acute exacerbation and functional decline, fitting `99491` patient criteria
`F03.90`	Unspecified dementia without behavioral disturbance	Cognitive impairment increases care complexity and need for care coordination and caregiver communication
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Chronic ischemic heart disease commonly coexists and contributes to overall morbidity requiring chronic care management
`M16.11`	Unilateral primary osteoarthritis, right hip	Significant musculoskeletal disease can cause functional decline and requires ongoing management planning

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Often billed for non-face-to-face clinical staff time; `99491` is the provider-performed first 30 minutes and may be used instead when physician/qualified professional time meets criteria
`99487`	Complex chronic care management services, first hour of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used for complex CCM involving at least 60 minutes of clinical staff time; complements `99491` when additional complex care management is provided by staff
`99489`	Complex chronic care management services, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used to report additional time beyond the initial complex CCM; workflow may include both provider time (`99491`) and staff time codes
`99495`	Transitional care management services with moderate medical decision complexity (face-to-face within 14 days)	May be billed in the post-discharge period when a transition of care occurs; differs from monthly chronic care management but commonly coordinates with CCM workflows
`99496`	Transitional care management services with high medical decision complexity (face-to-face within 7 days)	Similar to `99495` for higher complexity transitions; may be part of the overall care plan coordination that complements `99491`

CPT 99487: Complex Chronic Care Management, First 60 Minutes

CPT-99489-PROVIDER-DIRECTED-CLINICAL-STAFF-CARE-COORDINATION-COMPLEX-CHRONIC-CONDITIONS

CPT 99489: Provider-Directed Clinical Staff Care Coordination for Complex Chronic Conditions

CPT-99490-CHRONIC-CARE-MANAGEMENT-PROVIDER-DIRECTED-20-MIN

CPT 99490: Provider-Directed Chronic Care Management, First 20 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 99491: Chronic Care Management, Physician Personal 30 Minutes

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Billing Code Overview

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CPT 99491: Chronic Care Management, Physician Personal 30 Minutes

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References