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See a sample rate comparisonCPT 99439 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Management Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
| Medicare Fee Schedule | $50.44 national non-facility rate (2026) · View Medicare rates for 99439 |
| Medicaid Fee Schedule | $38.905 median of the 8 states in the free preview · View Medicaid rates for 99439 |
National average reimbursement for CPT 99439 by major payers:
$52.51
$49.52
$47.48
$73.70
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CPT 99439
5 of 25 sample ratesHigher to lower in this preview
Gabriel Greenhaw
Texas Health Physicians Group
$128.30Published rateRobert Anderson
Texas Health Physicians Group
$76.01Published rateNancy Nagda
Milford Regional Physician Group Inc
$40.38Published rateSandy Shah
Heart Disease Center PA
$31.76Published ratePedro Abanto
Wound Care Institute Of Texas PLLC
$21.92Published rate
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See a sample payer proposalCPT 99439 vs. Other Care Management Services Codes
The CPT 99439 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 99439 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 99439. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99439 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services and procedures. They are crucial for accurate medical billing and for communicating information about medical services and procedures among physicians, patients, and third-party payers.
To find out the cost of a medical procedure or service, especially for your specific situation, it's best to use a tool that provides detailed pricing information based on CPT codes and your location. For this, you can use Payerprice's fee schedule lookup tool, which allows you to search with the CPT code and specific location to get relevant pricing data.
Fee schedules for specific medical services can vary significantly. To look up fee schedules relevant to your specific CPT code and location, it is recommended to use a specialized tool like Payerprice. Their fee schedule lookup tool enables users to search for pricing information tailored to their specific needs.
Yes, medical service prices can vary significantly by location, healthcare provider, and insurance plan. Factors such as regional cost of living, facility fees, negotiated rates with insurance companies, and the specific healthcare provider's charges all contribute to these variations.
Yes, to help estimate your out-of-pocket costs for a specific medical procedure, especially considering different CPT codes and locations, you can utilize Payerprice's fee schedule lookup tool. This tool is designed to provide users with the ability to search for pricing information based on CPT codes and specific locations, which can help in estimating potential costs.