Category
Chronic Care Management Services
CODE TYPE
Timed-based code
Billed in 30 minutes increment
Primary Code
99491
CPT 99437 is an add-on code for 99491 and is billed to patients receiving chronic care management services, for each additional 30 minutes of clinical staff time provided personally by a physician or other qualified health care professional. It can be billed once a month.
CODING CRITERIA
For CPT 99437, the following criteria should be met:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- For each additional 30 minutes of clinical staff time provided personally by a physician or other qualified health care professional
- Chronic conditions that lead to the risk of death, acute exacerbation/decompensation, or functional decline of patient
- Comprehensive care plan established, implemented, revised, or monitored
- Billed once a month.
BILLING CRITERIA
Providers cannot bill more than one CCM claim for a patient per calendar month i.e. 30 days
CODE FIRST:
CPT code 99437 requires code first condition i.e. 99491
