CPT 99437E&M

Chrnc care mgmt phys ea addl

CPT 99437 covers additional time spent managing chronic conditions for patients with two or more serious health problems. It's an add-on code used when healthcare teams spend extra time beyond the initial 20 minutes coordinating care each month.

Showing rates for

National Average

Base Medicare rate

$57.58

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

PE RVU (NF)

0.72

MP RVU

0.06

Total RVU

1.78

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always bill 99437 in conjunction with base code 99490 or 99487; it cannot be billed alone as it is an add-on code
Impact: Prevents automatic denial; ensures proper code pairing for full reimbursement
Document exact time spent in increments of 20 minutes; bill one unit of 99437 for each additional 20 minutes beyond the base code threshold
Impact: Each unit generates $57.58; 60 total minutes allows billing 99490 + two units of 99437 for total of $172.74
Obtain written patient consent before initiating chronic care management services and document consent in the medical record
Impact: Missing consent is the leading denial reason; proper consent documentation protects $57.58 per unit from audit recoupment
Track time separately from same-day E/M services; CCM time must occur on non-face-to-face days during the calendar month
Impact: Prevents bundling denials; allows capture of all eligible CCM time throughout the month
Bill only once per calendar month per patient regardless of how many additional 20-minute increments; report multiple units on single claim line
Impact: Proper reporting of multiple units (e.g., 2 units = $115.16) on one date prevents processing errors
Ensure comprehensive care plan is electronically accessible and includes medication reconciliation, functional status assessment, and care coordination documentation
Impact: Audit-proof documentation protects against post-payment review recoupment of all CCM reimbursement

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Frequently asked questions

How much does Medicare pay for CPT code 99437 in 2025?

Medicare pays $57.58 for CPT 99437 under the non-facility rate in 2025, and $47.87 under the facility rate. This represents payment for each additional 20 minutes of chronic care management beyond the base code threshold.

Can CPT 99437 be billed alone or does it require another code?

CPT 99437 cannot be billed alone; it is an add-on code that must be reported with either base code 99490 (simple chronic care management) or 99487 (complex chronic care management). It represents additional 20-minute increments beyond the base service time.

How many times can you bill 99437 in one month?

You can bill multiple units of 99437 in one calendar month for the same patient, with each unit representing an additional 20 minutes of service time. For example, 60 total minutes allows billing 99490 plus two units of 99437. Report all units on a single claim line dated within the service month.

What is the time requirement for billing CPT 99437?

CPT 99437 requires a minimum of 20 additional minutes of clinical staff time beyond the base chronic care management code threshold. Time must be documented with specific start/stop times and activities performed during the calendar month.

Do patients need to consent to bill 99437?

Yes, written patient consent is required before billing any chronic care management codes including 99437. Consent must be documented in the medical record and obtained prior to the first month of billing. Missing consent is the most common reason for claim denials and audit recoupments.

What are the work RVUs for CPT 99437?

CPT 99437 has 1.0 work RVU, 0.72 practice expense RVU (non-facility), 0.42 practice expense RVU (facility), and 0.06 malpractice RVU, for a total of 1.78 RVUs in 2025. The conversion factor is 32.3465.

Can 99437 be billed on the same day as an office visit?

The chronic care management time counted toward 99437 cannot occur on the same day as a face-to-face E/M visit. However, you can bill for CCM services and office visits in the same calendar month as long as the CCM activities are performed on different days throughout the month.