Fam Pract Manag. 2019 Jul-Aug;26(4):34.

Author disclosure: no relevant financial affiliations disclosed.



Who may perform chronic care management (CCM) services described by CPT code 99491?


CPT introduced code 99491 this year to cover services provided by a physician, nurse practitioner (NP), or physician assistant (PA) who personally performs 30 minutes of CCM during a calendar month. CCM codes 99487-99490 are for work performed by clinical staff and are valued accordingly. Code 99491 is valued at a higher rate because it describes work that only a physician, NP, or PA may perform. It is worth 1.45 work relative value units and a national, nonfacility rate of about $84.

The CCM codes share these requirements:

  • A care plan is established for a patient with two or more significant chronic illnesses expected to last at least 12 months or until the death of the patient.

  • Verbal consent for CCM services is required and must be documented in the medical record.

  • The activities performed and the time spent on these activities must be documented in the medical record.

  • The threshold time to bill 99491 is 30 minutes in a calendar month. This time can be spread over multiple days during the month.

  • The service can be provided to patients who are living at home, in assisted living, or in a rest home or domiciliary care.



How should we code for the initial evaluation of a patient with pelvic organ prolapse or stress urinary incontinence?


You would code for a problem-oriented office visit. This could be for a new or established patient or billed in addition to a preventive medicine or wellness visit if there is a distinct history, exam, and medical decision making related to the patient's condition. If a pessary is fitted and supplied on the same day as the E/M service, bill CPT code 57160, “Fitting and insertion of pessary or other intravaginal support device,” and HCPCS code A4561, “Pessary, rubber, any type,” or A4562, “Pessary, nonrubber, any type,


Betsy Nicoletti is a speaker and consultant in coding education, billing, and accounts receivable. She lives in Northampton, Mass.

Author disclosure: no relevant financial affiliations disclosed.


Send questions and comments to, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.


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