A time-based chronic care management code (CPT 99491) describes the work of a qualified provider to establish, implement, revise, or monitor the care plan for a patient with two or more chronic continuous or episodic health conditions that are expected to last at least 12 months (or until the death of the patient) and put the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.

Read also: When to use  CPT code 99453, 99454 & 99457

Description of CPT code 99437, 99439, 99490, 99491

Care management services are defined as those management and support services that are 1) rendered by clinical staff while under the direction of a clinician who may be a physician or other qualified health care professional (QHP) or 2) provided personally by a physician or other QHP to a patient who resides in a personal residence or in an assisted living facility, domiciliary, or rest home.

Some components of care management services include the establishment, implementation, monitoring, or revision of the patient’s individual care plan; coordination of the care provided by other agencies and professionals; and education afforded to the patient or their caregiver regarding the patient’s care plan, condition, and prognosis. Intended to improve coordination of care and patient engagement while reducing hospitalizations and disjointed care, care management services also take into account the patient’s other medical conditions, psychosocial needs, and normal activities of daily living (ADL).

Chronic care management services are represented by resequenced codes 99490, 99439, 99491, and 99437. Typically, patients receiving this care have a minimum of two and possibly more chronic ongoing or episodic health conditions that are anticipated to last at least one year (or until the patient expires) and that put the patient at increased risk of death, exacerbation, or functional decline. Chronic care management services include the establishment, implementation, revision, or monitoring of a comprehensive care plan.

CPT code 99490 should be reported once per calendar month for the first 20 minutes of clinical staff time when directed by a physician or other QHP; for each additional 20 minutes, report 99439. CPT code 99439 should not be reported more than twice per calendar month. CPT code 99491 is also reported once per calendar month and represents the first 30 minutes provided personally by the physician or other QHP involved with care management activities; report 99437 for each additional 30 minutes.

99491 — 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 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.

Code 99491 should be used to report the first 30 minutes of chronic care management services, per calendar month. Although the code may only be reported once by one provider, the time counted toward reporting the service is typically episodic and can be accumulated on multiple days over the calendar month by one or more providers and/or qualified health professionals in the group.

Read also: Practice Question and answers for CPC Exam

When to use CPT code 99491

Requirement for chornic care management  CPT codes (99437, 99439, 99490, 99491)

• Patients have two or more chronic continuous or episodic health conditions that are expected to last at least 12 months, or until the death of the patient.
• Conditions place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.

Complex chronic care management services (99487, 99489)

• Patients have two or more chronic continuous or episodic health conditions that are expected to last at least 12 months, or until the death of the patient.
• Patient assessments require moderate- or high-level MDM.
• Typical patients are treated with three or more prescription medications and may be receiving other types of therapeutic interventions (eg, physical therapy, occupational therapy).
• Conditions place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
• Patients have complex diseases and morbidities and demonstrate one or more of the following:
• Need for the coordination of a number of specialties and services
• Inability to perform activities of daily living (ADLs) and/or cognitive impairment resulting in poor adherence to the treatment plan without substantial assistance from a caregiver
• May have psychiatric and other medical comorbidities (eg, dementia and chronic obstructive pulmonary disease or substance abuse and diabetes) that complicate their care
• Social support requirements or difficulty with access to care