Reimbursement
$63.46
Threshold
30m
2026 Status
Active
What is CPT Code 99437?
CPT 99437 is defined as: Chronic care management (CCM) services provided personally by a physician or other qualified health care professional (QHP) for each additional 30 minutes beyond the first 30 minutes (99491) per calendar month. This add-on code covers the intensive management of patients with two or more chronic conditions that place them at significant risk.
This code is primarily used for CCM services. It falls under the category of Care Management / CCM and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1
Physician Effort
PE (Non-Fac)
0.82
Practice Expense
Malpractice
0.08
Risk Factor
Total RVU
1.9
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% efficiency adjustment. Time-based care management services are protected to encourage provider-led management of high-risk populations.
provider value
The 2026 rule preserves the higher RVU for provider time (99491/99437) relative to staff-led CCM (99490/99439), rewarding professional intensive care.
conversion factor
Utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Operational Requirements
time threshold
Each unit represents 30 minutes of personal time by the MD/NP/PA. Unit 1 of 99437 requires reaching 60 total minutes (30 mins for 99491 + 30 mins for 99437).
provider personally
Clinical staff time (RN/MA) cannot be counted toward 99437. It is strictly for physician or QHP personal effort.
documentation content
Requires documentation of specific clinical activities such as data analysis, plan revision, and coordination with other providers.
unit limit
Typically limited to 2 units per month by MUE, though more may be billed with proof of clinical necessity.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Exempt from the mandatory -2.5% efficiency cut. Must be billed with 99491.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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