99491
CCM physician 30 min/mo
Chronic care management services provided personally by a physician or other qualified healthcare professional, at least 30 minutes of clinician time per calendar month. CMS 2026 wRVU 1.45. The clinician-time analog of 99490 (which counts clinical-staff time directed by the clinician). Used when the billing clinician personally performs the CCM work rather than delegating to clinical staff.
Billing guidance for 99491 is locked
- When to use it: the exact clinical situations that support billing 99491
- Documentation checklist: the 8 elements your note needs before submitting
- Common pitfalls: the 7 mistakes that get 99491 downcoded or denied
Payer notes
Medicare and Medicare Advantage cover 99491 with patient cost share; some MA plans waive cost share as a value-based-care benefit. Commercial payers are mixed; many do not cover 99491 (Medicare-focused code). Document patient consent including any cost share each calendar year, not just at initiation. Practices typically combine 99491 with 99490 across their panel, using 99490 for delegable workflows and 99491 for high-complexity patients where you personally coordinate. The wRVU on 99491 (1.45) is materially higher than 99490 (1.00), making it worth tracking which patients warrant clinician-personal CCM.