CPT Code 99489 For Complex Chronic Care Management (CCCM)

By Prateek Haswani | July 9, 2024

For patients with multiple chronic diseases, CPT Code 99489 is an add-on code to CPT 99487 and used for Complex Chronic Care Management (CCCM) services. This code reimburses physicians or clinicians for the additional time they need to provide treatment and advice to patients’ in complex care scenarios.

Coding Criteria For CCCM Code 99489

CPT code 99489 has the same eligibility requirements as CCCM CPT Code 99487. There is no limit on how many times a provider can bill code 99489 in a single month. For CPT 99489, the following criteria should be met:

Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
Chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
Comprehensive care plan established, implemented, revised, or monitored.
This is an add-on code for complex CCM service, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional
Billed as per calendar month in addition to code for primary procedure.

Table of Contents

What Services Are Required For Reimbursement?

To bill for CPT 99489, you must comply with the following conditions:

At least 30 minutes per month for clinical staff time, over and above the 60-minute time block under CPT code 99487.
Directed by a qualified physician or nurse practitioner.
A thorough care plan created or combined from an existing care plan.
Complex medical decision-making.

This code has to be used along with CPT 99487 to establish a care plan or substantially revise an existing plan. A care plan should include a complete assessment of patient needs taking into account the physical, functional, psychological and environmental conditions of the patient.

Guidelines For Billing CPT Code 99489

Providers cannot bill more than one CCM claim for a patient per calendar month i.e. 30 days.
Can only be billed as an add-on code to CPT 99487
Cannot be billed with CPT 99490 (the 30-minute add-on code for 99490 is 99439)

To bill 99487 and 99489 in the same month, a total of 90 minutes (60+30) needs to be spent on caring for the patient under CCCM. The national average reimbursement for CPT code 99489 in 2024 is $71.06*. (*The actual reimbursement amount will vary by region and provider).

Documentation Required For Billing Code 99489

Date and duration of interaction with the patient
Care team member name and credentials
Identification of provider or community agency
Nature of discussion and pertinent details focusing on care coordination services pertinent to patient’s individual care plan

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Frequently Asked Questions (FAQs)

1) What is CPT 99489?

An add-on code to 99487 that accounts for each additional 30 minutes of complex CCM services furnished by clinical staff under the direction of the billing practitioner, per calendar month. It cannot be used without 99487.

2) When can I report 99489?

You can only report 99489 after you have completed the initial 60 minutes of complex CCM under 99487 within the same calendar month; 99489 accounts for each additional 30-minute increment beyond that first hour.

3) Can 99489 be billed by itself?

No. 99489 must be billed with 99487; it’s not payable as a stand-alone service.

4) Who can bill, and whose time counts toward 99487/99489?

Eligible billing practitioners include physicians, NPs, PAs, CNSs, and CNMs. For 99487/99489, clinical staff time under the practitioner’s direction counts toward thresholds (general supervision). Practitioner time may also count unless you’re reporting practitioner-only CCM codes (99491/99437).

5) What level of medical decision-making is required for complex CCM?

The billing practitioner must perform moderate-to-high complexity medical decision-making (MDM) during the service period. This work cannot be delegated.

6) Which patients qualify?

Patients with two or more chronic conditions expected to last 12 months or more (or until end of life) that place them at significant risk of death, acute exacerbation/decompensation, or functional decline.

7) What scope of service must be in place for complex CCM?

A documented electronic comprehensive care plan; 24/7 access and continuity; comprehensive care management (e.g., medication review, preventive care); and management of care transitions.

8) Is an initiating visit required?

Yes. For new patients or those not seen within the past year, complex CCM must be initiated during a face-to-face visit (e.g., E/M, AWV, or IPPE).

9) Do we need patient consent?

Yes. Obtain and document verbal or written consent before billing. Only one practitioner can bill CCM for each patient per calendar month.

10) What documentation supports 99487/99489?

The required documentation includes time logs that meet the thresholds, a comprehensive and up-to-date care plan, evidence of medical decision-making (MDM) by the billing practitioner, care coordination and transition notes, and documented patient consent.

11) Can I bill non-complex CCM (99490/99439) in the same month as complex CCM (99487/99489)?

No. Non-complex and complex CCM cannot be reported for the same patient in the same month. Practitioner-only CCM (99491/99437) also cannot be reported in a month when 99487/99489/99490/99439 are used.

12) What other bundling/exclusivity rules matter?

You may report CCM during the TCM 30-day period (99495/99496). You may not count the same minutes toward any other billed service, and complex CCM cannot be reported in the same month as prolonged E/M services.

13) Can CCM be furnished while a patient is in a facility?

Yes. Report the place of service where you would ordinarily provide face-to-face care. Complex CCM is recognized in both facility and non-facility contexts.

14) When is the date of service for 99487/99489?

The service period is one calendar month; report the code(s) at the end of the month.

15) Can I bill CCM alongside RPM or RTM?

You may bill either RPM or RTM concurrently with CCM/TCM (not both), as long as time isn’t double-counted and each program’s requirements are fully met.

16) What supervision standard applies to 99487/99489?

General supervision: services are furnished by clinical staff under the billing practitioner’s overall direction and control; the practitioner does not need to be physically present during provision.

17) Can external clinical staff help deliver CCM?

Yes—if incident-to requirements are met and the work is clinically integrated with the billing practitioner. Work performed outside the U.S. is not allowable for non-emergency Medicare services.

18) Common pitfalls that lead to denials for 99489?