Does anyone have experience billing CPT 99091 versus 99490 along with CPT codes 99453, 99454 and 99457? CPT 99091 requires 30 minutes physician/QHCP time whereas 99490 requires 20 minutes but could be by clinical staff. CPT 99457 also requires 20 minutes and can be by clinical staff. The scenario in discussion is that the physician/QHCP is spending time during month span separate from the time spent by the clinical staff and want to capture both if CPT codes permit.