CPT Code 99489 For Complex Chronic Care Management (CCCM)

complex chronic care management

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.

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

Streamline CCCM With HealthArc’s Chronic Care Management Platform

HealthArc is your dependable choice for improving patient outcomes and reimbursement management. Our Chronic Care Management (CCM) software is intended to simplify patient monitoring and management while scaling your healthcare outcomes.

We have a suite of FDA-approved remote monitoring devices, clinical software, physicians’ dashboard, and billing capabilities set up to deliver accurate and efficient billing for CCCM CPT  code 99489.

Please request a free demo to learn about how we can help your organization achieve its care coordination goals. Feel free to talk to our team at +201 885 5571 for any queries about the CCCM codes.