CPT code 99491: Chronic care management, 30 minutes, physician/QHP time2026 Medicare rate & RVUs in Rhode Island

In Rhode Island, Medicare pays $91.00 for 99491 in the office and $66.50 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99491 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99491 covers

This service coordinates ongoing care for a patient with at least two chronic conditions expected to last at least 12 months or until death, when those conditions create significant risk of exacerbation, decline, or loss of function. A physician or other qualified health care professional personally performs the care-management work, which may include updating the care plan, coordinating with other treating professionals, and managing medications. Work is generally performed outside a face-to-face visit and may address conditions such as diabetes, heart failure, or COPD.

Report 99491 when the physician or qualified health care professional personally furnishes at least 30 minutes of qualifying CCM work during the calendar month. Select it based on the personally furnished time, not the combined time of the whole care team; clinical staff minutes do not meet this code’s time threshold. Documentation should support the patient’s qualifying conditions, the care plan and coordination performed, and the practitioner’s time for the month.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Rhode Island compares for 99491

Across 109 of 109 payment localities, the office rate for 99491 runs from $82.64 in Arkansas to $115.23 in Alaska. Rhode Island pays $91.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99491 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99491 in every payment locality

How the 99491 rate is calculated

Each of 99491’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99491

99491 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Codes related to 99491

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99491 has changed in Rhode Island

Price 99491 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

• Ashaway
• Bradford
• Carolina
• Central Falls
• Charlestown
• Chepachet
• Clayville
• Cranston

Browse all communities in Rhode Island

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates