CPT 99491: Chronic Care Management, Physician First 30 Minutes
CPT 99491 reports the first 30 minutes of chronic care management provided personally by a physician or QHP per calendar month for a patient with two or more chronic conditions. In 2026 Medicare pays about $89.18 non-facility (2.67 total RVUs times the $33.4009 conversion factor) and about $65.47 in a facility.
- Code type
- CCM (physician/QHP personal time)
- 2026 non-facility
- $89.18 (2.67 RVUs)
- 2026 facility
- $65.47 (1.96 RVUs)
- Requirement
- 30 min physician/QHP time / month
What is CPT 99491 used for?
CPT 99491 reports chronic care management delivered personally by the physician or QHP, the first 30 minutes per calendar month, for a patient with two or more chronic conditions. Unlike 99490, which pays for clinical staff time under direction, 99491 pays for the practitioner's own care-management time.
The eligibility rules mirror the rest of the CCM family: two or more chronic conditions expected to last at least 12 months, documented patient consent, a comprehensive care plan, and 24/7 access. The distinguishing feature is who does the work. The 30 minutes must be personally furnished by the physician or QHP and cannot include clinical staff time, which is why 99491 pays more than the staff-based base code.
How much does 99491 pay in 2026?
99491 carries 2.67 non-facility RVUs and 1.96 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $89.18 non-facility and $65.47 in a facility per month. That is roughly $23 more than the staff-based 99490, reflecting the personal practitioner time. Check locality rates with the Medicare fee calculator.
Physician CCM or staff CCM: which pathway?
Pick the pathway that matches who actually does the work:
- Determine whose minutes they are: physician/QHP personal time, or clinical staff time under direction.
- If the physician or QHP personally spends the 30 minutes, bill 99491.
- If clinical staff perform the time under physician direction, bill 99490 plus 99439 instead.
Example: a physician who personally spends 32 documented minutes across the month reconciling medications, calling a specialist, and revising the plan for a patient with COPD and diabetes bills 99491 at about $89.18, and does not also bill 99490 for the same patient that month.
Frequently asked questions
99491 requires at least 30 minutes of chronic care management time provided personally by the physician or other qualified health professional in a calendar month, not clinical staff time. The patient must have two or more qualifying chronic conditions, documented consent, and a comprehensive care plan.
The 2026 national non-facility allowed amount is about $89.18 (2.67 total RVUs times $33.4009) and about $65.47 in a facility. It pays more than the staff-based 99490 because it reflects personal physician or QHP time.
No. For a given patient in a given month you choose one CCM pathway: staff-directed (99490 plus 99439) or physician-personal (99491). The same minutes cannot be counted in both, and mixing the two on one patient in one month is a common denial and audit trigger.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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