Care coordination is included in several programs; however, some codes are specifically intended to incorporate care coordination work across patients and populations.
HealthArc’s care coordination platform provides reimbursement for communication with specialists, medication management and reconciliation, patient and caregiver education, monitoring patient adherence, barriers to care, management of transitions, and more.
Brief Overview of the Care Coordination CPT Codes for 2026 and 2027
CPT 99487 – Complex Care Coordination, First 60 Minutes
- Used when care involves designing or revising a care plan, monitoring, and managing a patient with moderate-to-high complexity.
- Requires at least 60 minutes of clinical staff time under the direction of a physician or QHP.
- Care often includes multiple clinical conditions and complex social determinants.
CPT 99489 – Each Additional 30 Minutes (Add-On)
- Billed in addition to 99487 for each additional 30 minutes of staff or provider care coordination time.
- Extra time must be distinct from the previous time and properly documented.
CPT 99490 – Non-Complex Care Coordination (20 Minutes)
- Requires at least 20 minutes of clinical staff time in a given month.
- Applicable to patients with two or more chronic conditions expected to last 12 months or longer.
- Includes medication management, communication with other providers, and patient self-management support.
CPT 99491 – Physician/QHP Time, 30 Minutes
- Covers 30 minutes of care coordination conducted solely by a physician or QHP per calendar month.
- The physician or QHP must personally provide and document the time without clinical staff assistance.
CPT 99492–99494 & 99484 – Behavioral Health Integration (BHI) Codes
- While BHI has its own criteria, these codes also apply to specialized care coordination for behavioral and psychiatric management.
CPT 99495 & 99496 – Transitional Care Management (TCM)
- Transitional care management recognizes the intensive care coordination needed after hospital discharge.
- 99495: Moderate complexity — communication within 2 days and a face-to-face visit within 14 days of discharge.
- 99496: High complexity — communication within 2 days and a face-to-face visit within 7 days of discharge.
HCPCS Codes (e.g., G0506, G0511, G0512)
- For FQHCs and RHCs, care coordination services utilize G-codes, as CMS has established equivalents for these settings.
Who Can Bill Care Coordination CPT Codes?
- Physicians (MDs/DOs)
- Nurse Practitioners (NPs)
- Physician Assistants (PAs)
- Certified Nurse Midwives (CNMs)
- Clinical Nurse Specialists (CNSs)
Clinical staff (e.g., RNs, MAs) may provide the service under general supervision, but billing must be submitted under the supervising provider.
Medicare Reimbursement for Care Coordination Services in 2026 and 2027
Medicare national non-facility rates for the care coordination codes in 2026 and 2027:
| Code | What it covers | 2026 | 2027 (from Jan 1, 2027, CY2027 final rule) |
|---|---|---|---|
| 99487 | Complex CCM, first 60 minutes | $144.29 | $140.63 |
| 99489 | Complex CCM, each additional 30 minutes | $78.16 | $76.35 |
| 99490 | CCM, clinical staff, first 20 minutes | $66.13 | $63.63 |
| 99491 | CCM, physician/QHP, first 30 minutes | $89.18 | $85.49 |
| 99495 | TCM, moderate complexity, visit within 14 days | $220.11 | $212.41 |
| 99496 | TCM, high complexity, visit within 7 days | $298.60 | $289.42 |
Source: CMS Medicare Physician Fee Schedule, national non-facility amounts (total RVUs times the conversion factor). 2026: RVU26D, October 2026 file, $33.4009 conversion factor. 2027: CY2027 final rule (CMS-1848-F), Addendum B, $32.6286 conversion factor. Your payment is adjusted for your locality and setting, and commercial payers set their own rates. What changed in the 2027 final rule.
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