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See a sample rate comparisonCPT 99491 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 Svc 30 Min, Chronic Care Management Services Provided Personally By A Physician Or Other Qualified Health Care Professional At Least 30 Minutes Of Physician Or Other Qualified Health Care Professional Time Per Calendar Month 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 Place The Patient At Significant Risk Of Death Acute Exacerbation/Decompensation Or Functional Decline; Comprehensive Care Plan Established Implemented Revised Or Monitored.
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Management Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $89.18 national non-facility rate (2026) · View Medicare rates for 99491 |
| Medicaid Fee Schedule | $74.115 median of the 8 states in the free preview · View Medicaid rates for 99491 |
National average reimbursement for CPT 99491 by major payers:
$106.07
$104.03
$93.80
$137.51
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CPT 99491
5 of 25 sample ratesHigher to lower in this preview
Cynthia Kulik
Texas Health Physicians Group
$160.99Published rateValentine Ebuh
Medhealth
$104.33Published rateBasanti Vrushab
Basanti Vrushab Md PLLC
$83.97Published rateHealthy Me Clinic PLLC
$75.68Published rateInspire Health PLLC, Legacy Health Primary Care PLLC
Inspire Health PLLC
$62.97Published rate
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See a sample payer proposalCPT 99491 vs. Other Care Management Services Codes
The CPT 99491 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 99491 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 |
|---|---|---|
| 99487-CPT | Low | Cplx Chrnc Care 1st 60 Min, Complex 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 Moderate Or High Complexity Medical Decision Making First 60 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99489-CPT | Low | Cplx Chrnc Care Ea Addl 30, Complex 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 Moderate Or High Complexity Medical Decision Making Each Additional 30 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 |
| 99490-CPT | Low | Chrnc Care Mgmt Staff 1st 20, 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 First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99491-CPT | Low | Chrnc Care Mgmt Svc 30 Min, Chronic Care Management Services Provided Personally By A Physician Or Other Qualified Health Care Professional At Least 30 Minutes Of Physician Or Other Qualified Health Care Professional Time Per Calendar Month 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 Place The Patient At Significant Risk Of Death Acute Exacerbation/Decompensation Or Functional Decline; Comprehensive Care Plan Established Implemented Revised Or Monitored. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99491 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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