CPT 99491: CCM by the physician
CCM reported when the physician or other qualified practitioner personally spends at least 30 minutes in the month on care management, instead of clinical staff time.
CPT 99491 at a glance
- Time threshold
- 30 minutes personally performed by the practitioner per month
- Who performs it
- The physician or other qualified practitioner personally
- How often
- Once per patient per calendar month
- Approx. 2026 national rate
- ~$83
Not reported in the same month as 99490 or 99487 by the same practitioner.
What the record needs to show
- Two or more chronic conditions expected to last at least 12 months or until death, with significant risk of decline
- Practitioner time only; clinical staff minutes do not count toward this code
- Documented consent and a comprehensive care plan
- A time log attributing the 30 minutes to the practitioner
Common billing mistakes
- Counting staff time toward the practitioner's 30 minutes
- Billing 99491 and 99490 for the same patient in the same month
Where Zenith fits
Your practice stays the billing provider for CPT 99491. Zenith supplies trained clinical staff who do the work inside your EHR and invoice your practice for the labor. Zenith does not bill Medicare. See Chronic Care Management for how the program runs.
Educational summary, not billing or legal advice. Rates are 2026 Medicare national averages and vary by locality and payer. Confirm current rules in the CMS Physician Fee Schedule and with your Medicare Administrative Contractor.