CPT 99491 Fee Schedule

Last Verified: July 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	Chronic Care Management Services Care Management Services
Common Place of Service	11 - Office None 99 - Other POS
Common Modifiers	None 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99491

National average reimbursement for CPT 99491 by major payers:

$106.07

$104.03

$93.80

$137.51

Preview provider-level rates for...

For billing codeCPT 99491

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99491	$62.97	1477107522 - INSPIRE HEALTH PLLC, LEGACY HEALTH PRIMARY CARE PLLC	842188069 - (TX) INSPIRE HEALTH PLLC	TX	Internal Medicine Physician (207R00000X)
United	99491	$104.33	1598963175 - VALENTINE EBUH	752896138 - MEDHEALTH	TX	Internal Medicine Physician (207R00000X)
United	99491	$160.99	1912178567 - CYNTHIA KULIK	752613493 - TEXAS HEALTH PHYSICIANS GROUP	TX	Internal Medicine Physician (207R00000X)
United	99491	$86.76	1972794154 - MELISSA AMADOR	922465140	TX	Internal Medicine Physician (207R00000X)
United	99491	$71.48	1417140641 - SHAMIMA SATTAR	208164988 - (TX) UNIVERSAL PHYSICIANS PA	TX	Internal Medicine Physician (207R00000X)
United	99491	$125.20	1013925288 - VIDYA NANDIPATI	510601649 - (TX) VIDYA NANDIPATI MD PA	TX	Internal Medicine Physician (207R00000X)
United	99491	$94.18	1053398404 - MICHAEL SCHRADER	454972466	TX	Internal Medicine Physician (207R00000X)
United	99491	$67.26	1922016997 - QUAN LE	260436172	TX	Internal Medicine Physician (207R00000X)
United	99491	$71.48	1922468933 - TEXAS PHYSICIAN ASSOCIATES PLLC	811397984 - (TX) TEXAS PHYSICIAN ASSOCIATES PLLC	TX	Internal Medicine Physician (207R00000X)
United	99491	$134.83	1629005418 - RICHARD ARROYO-DIAZ	746003411	TX	Internal Medicine Physician (207R00000X)
United	99491	$109.51	1528210663 - CARDIOVASCULAR CONSULTANTS OF NORTH TEXAS, LLP	752931941 - (TX) CARDIOVASCULAR CONSULTANTS	TX	Cardiovascular Disease Physician (207RC0000X)
United	99491	$104.33	1396844064 - JOHN DUNCAN	752254247	TX	Cardiovascular Disease Physician (207RC0000X)
United	99491	$94.45	1578523999 - PIERRE LAUGHTON	900743550 - (MO) ST ANTHONYS PHYSICIAN ORGANIZATION HOSPITALIST SERVICES LC	TX	Internal Medicine Physician (207R00000X)
United	99491	$77.72	1689106791 - JUN YI LAI	760528576 - (TX) TIMBERLAND MEDICAL GROUP	TX	Internal Medicine Physician (207R00000X)
United	99491	$108.83	1750498820 - MONICA LEE	741586031	TX	Internal Medicine Physician (207R00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99491 vs. Other Care Management Services Codes

The CPT 99491 code is part of the Chronic Care Management Services 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
99455-CPT	Low	Work Related Disability Exam, Work Related Or Medical Disability Examination By The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report
99484-CPT	Low	Care Mgmt Svc Bhvl Hlth Cond, Care Management Services For Behavioral Health Conditions At Least 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month With The Following Required Elements Initial Assessment Or Follow Up Monitoring Including The Use Of Applicable Validated Rating Scales Behavioral Health Care Planning In Relation To Behavioral Psychiatric Health Problems Including Revision For Patients Who Are Not Progressing Or Whose Status Changes Facilitating And Coordinating Treatment Such As Psychotherapy Pharmacotherapy Counseling And Or Psychiatric Consultation And Continuity Of Care With A Designated Member Of The Care Team
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
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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99491) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo