Billing code 99491: Chronic care managementMedicare rate & RVUs in Oregon
Reports at least 30 minutes of chronic care management personally furnished by a physician or qualified health care professional for an eligible patient during a calendar month.
Medicare pays $88.14–$93.22 for 99491 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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.
Where 99491 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $93.22 | $66.87 |
| Rest Of Oregon | $88.14 | $64.52 |
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.
How the rate is built · 99491
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.50Practice expense 1.08Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99491
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$89.18
The facility rate would be $65.47 (+$23.71). In a facility, the facility bills its own costs separately.
99491 compared with similar codes
Compare codes
99491 vs 99490 vs 99487 vs 99484 vs 99495: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99490Chronic care management
- 99490 is based on clinical staff CCM time under practitioner direction. 99491 requires the physician or qualified health care professional to personally furnish the counted time.
- 99487Complex chronic care management
- 99487 is for complex CCM and uses its own complexity and clinical-staff time criteria. 99491 is based on at least 30 minutes personally furnished by a physician or qualified health care professional.
- 99484Behavioral health management
- 99484 describes behavioral health care management services. 99491 is the broader CCM pathway for patients who meet its chronic-condition criteria.
- 99495Transitional care management
- 99495 addresses transitional care after discharge and includes a required face-to-face visit. 99491 reports qualifying monthly chronic care management.
99491 billing questions
How is 99491 different from 99490?
99491 counts CCM time personally furnished by a physician or qualified health care professional. 99490 is the staff-time pathway, so choose based on who performed the documented work.
Can clinical staff minutes help reach the 30-minute threshold?
No. The threshold for 99491 is based on time personally furnished by the physician or qualified health care professional; staff time does not count toward it.
Is 99491 a face-to-face visit?
No. It reports monthly chronic care management work, which can include care planning and coordination outside a face-to-face encounter.
What should the record show?
Document the qualifying chronic conditions, the care plan and management activities, and a time record supporting at least 30 minutes personally furnished during the calendar month.
When would 99487 be a better fit?
Consider 99487 for complex chronic care management when its complexity and clinical-staff time criteria are met. 99491 is selected for qualifying physician or qualified health care professional time.
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
Show the CMS file lines behind this rate
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