All About CPT 99487 – Complex Chronic Care Management

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

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.