CPT 99491
Global XXX ActiveChrnc care mgmt phys 1st 30
CPT 99491 Billing & Documentation Guide
CPT code 99491 (Chrnc care mgmt phys 1st 30) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.5, a non-facility practice expense RVU of 1.08, and a malpractice RVU of 0.09, a total non-facility RVU of 2.67 and facility RVU of 1.96. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $91.35, though rates vary from $82.64 to $115.23 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99491, 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 99491 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99491 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 99491
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.5 | 1.5 |
| Practice Expense RVU | 1.08 | 0.37 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 2.67 | 1.96 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99491
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 | $96.21 | $68.15 | $92.1 - $109.24 | 29 |
| Florida | $92.15 | $68.35 | $89.11 - $95.26 | 3 |
| Georgia | $88.19 | $65.57 | $85.86 - $90.51 | 2 |
| Illinois | $90.88 | $67.96 | $87.73 - $93.6 | 4 |
| Michigan | $88.21 | $65.94 | $86.43 - $89.98 | 2 |
| North Carolina | $85.68 | $63.55 | $85.68 - $85.68 | 1 |
| New York | $96.8 | $70.35 | $86.48 - $101.78 | 5 |
| Ohio | $86.07 | $64.41 | $86.07 - $86.07 | 1 |
| Pennsylvania | $89.1 | $65.87 | $86.06 - $92.14 | 2 |
| Texas | $88.68 | $65.34 | $85.72 - $91.03 | 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 99491
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99491 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0373T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0405T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0469T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0488T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 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 |
| 90951 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90952 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90953 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99491
What does CPT code 99491 mean? +
CPT code 99491 represents: Chrnc care mgmt phys 1st 30. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99491? +
The 2026 Medicare national average non-facility payment for CPT 99491 is $91.35. Rates range from $82.64 to $115.23 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99491? +
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 99491? +
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 May 31, 2026.
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