All About CPT 99487 – Complex Chronic Care Management

By HealthArc | March 22, 2024

Complex chronic care management (CCCM) help patients manage multiple chronic conditions more effectively by improving the communication gap with the clinicians. It also benefits the healthcare providers by finding a way to maximize reimbursements and optimize the revenue for their practice.

Complex chronic care management requires two or more chronic conditions with high complexity decision making and comparatively longer billing thresholds than chronic care management (CCM). CCCM services includes crafting or amending a comprehensive care plan, making moderate-to-high-complexity medical decisions, and having a physician or a nurse practitioner manage or oversee clinical session for 60 minutes each month of the calendar year for CPT Code 99487 and CPT Code 99489.

CCCM comes into play when a chronically ill patient demonstrates or looks for the following:

need to coordinate a number of health services
unable to perform daily living activities, resulting in poor adherence to a treatment plan
psychiatric and other medical comorbidities that complicate their care
need access to care and social support

Table of Contents

What Is CPT Code 99487?

The Medicare billing code for Complex Chronic Care Management (CCCM) services for patients with multiple, i.e. two or more chronic illnesses is CPT Code 99487. This code was designated to cover patients who needed longer than the 20 minutes of virtual care every month covered under CPT Code 99490.

Medicare reimburses CPT 99487 to cover the additional time required for providing care coordination services to patients with chronic conditions. This code covers the first 60 minutes of non-face-to-face care coordination provided by the physicians and healthcare providers.

Eligibility Criteria for CPT Code 99487

The eligibility requirements for CPT Code 99487 are:

Patients with at least two chronic illnesses (e.g. diabetes, hypertension, rheumatoid arthritis, cancer) , requiring moderate to high complexity of decision making and expected to last for at least 12 months
Chronic conditions that put a patient at risk for serious harm, injury, or even death, if not treated regularly.
A comprehensive care plan that is created, implemented, updated, or tracked
Making moderately to highly complicated or challenging medical decisions
A doctor or physician or nurse practitioner will oversee 60 minutes of clinical staff time
Can only be billed once per calendar month

When Can You Bill For CCCM CPT Code 99487?

Patients will rarely require complex chronic care management services on a monthly basis, unless they are critically ill and require ongoing monitoring. The following billing requirements must be met:

A patient with several chronic conditions is in need of a specific treatment plan.
A patient’s treatment plan requires considerable changes after a hospital stay.
A patient needing a change in medication and lifestyle following a chronic illness.

Billing CPT Code 99487 With CPT Code 99490

CPT Code 99490 is the baseline code for Chronic Care Management, which can be billed for at least 20 minutes of CCCM services. If you bill for CPT Code 99490, you can’t bill for 99487.

Healthcare providers cannot bill for more than one CCCM claim per patient every calendar month.

What Services Are Required To Claim A Reimbursement?

In 2024, the average payment for non-facility CCCM CPT Code 99487 is $132. To be eligible for reimbursement, the following must be completed:

A minimum of one hour of clinical staff time every 30 days.
Care guidance from a physician or nurse practitioner
Comprehensive care plan or change of an existing care plan.
Complex medical decision-making.

Streamline CCCM with HealthArc’s Digital Health Platform

HealthArc is your reliable partner for better patient outcomes and reimbursement management. Our Chronic Care Management (CCM) software is designed to improve patient monitoring and simplify care management while increasing healthcare outcomes.

We have put up a suite of FDA-approved remote monitoring devices, clinical software, physicians’ dashboards, and billing tools to provide accurate and efficient CCCM services. By combining remote patient monitoring (RPM) with CCCM services, our platform is designed to improve patient care, streamline the healthcare process, and increase the practice revenue for your virtual care organization.

Please request a free demo to discover how we can help your organization reach its chronic care management objectives. Contact our team at +201 885 5571 for any questions concerning the CCCM codes.

Frequently Asked Questions (FAQs)

Q1. What does CPT code 99487 relate to?

CPT code 99487 is intended for billing for complex chronic care management services given to patients suffering from two or more chronic conditions that are likely to persist for more than 12 months (or until death) and are associated with significant risks of death, acute exacerbation, or functional decline.

Q2. What qualifies 99487 as “complex” care management?

This code is deemed to be “complex” due to the following reasons:

60 minutes of non–face-to-face care within one month
Moderate- or high-complexity medical decision-making
A comprehensive, patient-centered care plan that is routinely updated

Q3. Which professionals are authorized to bill CPT 99487?

This code can be billed by physicians, nurse practitioners, physician assistants, and other eligible providers. These providers often bill for this code with the support of clinical staff who work under general supervision.

Q4. In what ways is 99487 different from other CCM codes like 99490?

99490: Standard CCM; 20 minutes/month of care management
99487: Complex CCM; 60 minutes/month plus higher medical decision-making requirements
99489: Add-on code for each additional 30 minutes of complex CCM billing after the first 60 minutes

Q5. Which services are covered under CPT 99487?

Services may cover:

Care planning in detail and assessment
Management of medications
Coordination with other healthcare specialists and providers
Active surveillance of chronic diseases
Providing education to patients and their caregivers about compliance and clinical outcomes is essential

Q6. Would it be possible to bill other care management codes in conjunction with CPT 99487?

Yes, but not during the same period of time with other codes such as 99490 and 99491 for the same patient. However, it is possible to bill with RPM (remote patient monitoring) and other services if time and other conditions are satisfied.

Q7. What is the billing frequency for 99487?

As long as all the time and complexity criteria are met, it can be billed once for each patient in a month.

Q8. What are the non-invasive requirements for CPT 99487?

Required documentation includes:

Chronic conditions should be specified with numerical values
The patient-centered care plan
Time documented for the submission of complex care coordination services
Degree of medical decision-making (moderate or high-level complexity)
Care coordination delivered with other providers and healthcare system professionals

Q9. Is there a reimbursement from Medicare for 99487?

Yes. CPT 99487 is reimbursed by Medicare with an average national rate of $92 to $95 per month, subject to geographical adjustments. Other private payers may reimburse for the codes as well.

Q10. Are these services deliverable through telehealth?

Yes. Services like detailed discussions, phone calls, patient portals, and telehealth platforms can help coordinate care and communicate complex CCM services without needing to meet patients in person, making it easier for patients to access care.

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