How to Bill CPT 99496 for Care Management and Prolonged Services

When to Use CPT Code 99496

CPT 99496 is used for care management or prolonged evaluation and management services.

• •Service type: Care coordination / management
• •Focus: Ongoing patient support outside standard visits
• •Billing basis: Time-based, non-face-to-face services

Common scenarios:

• •Managing chronic conditions
• •Coordinating post-discharge care
• •Behavioral health care integration
• •Extended provider time beyond typical E/M thresholds

Insurance Verification Tips for CPT 99496

1. •Confirm payer participation in care management programs.
2. •Verify minimum time thresholds are met.
3. •Ensure patient consent when required.
4. •Avoid duplicate billing with overlapping services.

Example Case of CPT 99496

A provider spends documented time coordinating care, reviewing records, and communicating with the patient outside of a standard visit.
The service is billed as one unit of CPT 99496.