CPT 99437
Global ZZZ ActiveChrnc care mgmt phys ea addl
CPT 99437 Billing & Documentation Guide
CPT code 99437 (Chrnc care mgmt phys ea addl) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1, a non-facility practice expense RVU of 0.82, and a malpractice RVU of 0.07, a total non-facility RVU of 1.89 and facility RVU of 1.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $64.67, though rates vary from $58.13 to $80.56 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99437, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99437 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 99437 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99437
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1 | 1 |
| Practice Expense RVU | 0.82 | 0.24 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 1.89 | 1.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99437
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $68.27 | $45.35 | $65.24 - $77.82 | 29 |
| Florida | $65.43 | $46 | $63.1 - $67.83 | 3 |
| Georgia | $62.38 | $43.9 | $60.62 - $64.14 | 2 |
| Illinois | $64.45 | $45.73 | $62.06 - $66.53 | 4 |
| Michigan | $62.41 | $44.22 | $61.05 - $63.77 | 2 |
| North Carolina | $60.45 | $42.37 | $60.45 - $60.45 | 1 |
| New York | $68.72 | $47.11 | $61.06 - $72.45 | 5 |
| Ohio | $60.76 | $43.08 | $60.76 - $60.76 | 1 |
| Pennsylvania | $63.03 | $44.06 | $60.75 - $65.3 | 2 |
| Texas | $62.72 | $43.65 | $60.5 - $64.52 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99437
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99437 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90960 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90961 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90962 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90963 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90964 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90965 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90966 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90967 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99437
What does CPT code 99437 mean? +
CPT code 99437 represents: Chrnc care mgmt phys ea addl. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99437? +
The 2026 Medicare national average non-facility payment for CPT 99437 is $64.67. Rates range from $58.13 to $80.56 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99437? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99437? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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