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See a sample rate comparisonCPT 99437 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Chrnc Care Mgmt Phys Ea Addl, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Each Additional 30 Minutes By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Management Services |
| Common Place of Service | 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $63.13 national non-facility rate (2026) · View Medicare rates for 99437 |
| Medicaid Fee Schedule | $51.485 median of the 8 states in the free preview · View Medicaid rates for 99437 |
National average reimbursement for CPT 99437 by major payers:
$72.08
$78.48
$64.80
$103.59
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CPT 99437
5 of 25 sample ratesHigher to lower in this preview
Ryan Brewster
Beth Israel Deaconess Medical Center Inc
$199.80Published rateMichael Prete
Austin Regional Clinic PA
$94.84Published rateQing Liu
Memorial Hermann Medical Group
$87.06Published rateSteve Cole
Central Texas Hospitalists, P.A.
$79.65Published rateServe All Medical Tyler, PLLC, Clinica Hispana
Serve All Medical Tyler PLLC
$51.09Published rate
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See a sample payer proposalCPT 99437 vs. Other Care Management Services Codes
The CPT 99437 code is part of the Evaluation and Management services used for Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99437 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99415-CPT | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; First Hour (List Separately In Addition To Code For Outpatient Evaluation And Management Service) (Desc Rvsd 1/1/21) |
| 99416-CPT | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) (Desc Rvsd 1/1/21) |
| 99437-CPT | Low | Chrnc Care Mgmt Phys Ea Addl, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Each Additional 30 Minutes By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure |
| 99439-CPT | Low | Chrnc Care Mgmt Staf Ea Addl, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored Each Additional 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99437. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99437 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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