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    v1.0.30
    OpenPayerBilling CodesComplex Chronic Care Management ServicesCPT cpt-99487-complex-chronic-care-management-first-60-minutes
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    CPT 99487: Complex Care Management for Multiple Chronic Conditions

    Medicare pays $149 on average nationally for this procedure.

    CPT code 99487 describes provider-directed clinical staff time for complex care management of patients with two or more chronic conditions posing significant risk of death, acute exacerbation, decompensation, or functional decline; this service covers the first 60 minutes of clinical staff time per calendar month and is typically delivered as care coordination and care management services in outpatient clinic, primary care, or care management program settings.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    Clinical & Coding Specifications

    Clinical Context

    A 78-year-old patient with advanced congestive heart failure and stage 3 chronic kidney disease is enrolled in a primary care practice's complex chronic care management program. The patient has frequent medication changes, coordination needs among cardiology, nephrology, home health nursing, and pharmacy, and recent episodes of shortness of breath and fluid overload that increased risk of hospitalization. Each calendar month a provider-directed clinical staff team (registered nurse and care coordinator) spends time on activities such as medication reconciliation, care plan updates, telephonic outreach to specialty clinics, arranging home services, documenting goals of care, and facilitating transitions after recent ED visits. The first 60 minutes of that provider-directed clinical staff time in the month is billed using 99487. Typical workflow includes care plan development by the provider, delegation of coordination tasks to clinical staff, documentation of time and services in the medical record, and monthly attestation by the supervising provider that care was directed and reviewed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99490Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar monthLower-complexity monthly care management service often used when patient risk or time does not meet 99487 requirements
    99489Each additional 30 minutes of chronic care management services, per calendar month (add-on to 99487/99490)Used to report additional provider-directed clinical staff time beyond the primary time units billed with 99487
    99491Chronic care management services provided personally by a physician or other qualified health care professional, at least 30 minutes of physician/provider time, per calendar monthReported when the provider personally furnishes the time-intensive portion of chronic care management rather than delegating to clinical staff
    99358Prolonged evaluation and management service before and/or after direct patient care; first hourMay be relevant when prolonged non-face-to-face care coordination extends beyond standard chronic care management timing and documentation supports prolonged service reporting
    99495Transitional care management services with moderate complexity (face-to-face within 14 days, non-face-to-face services)May be billed for transitional activities around hospital discharge that overlap with or precede month-based chronic care management efforts

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207Q00000X
    207RC0000X
    207L00000X
    163WM0705X
    207SC0300X
    343800000X
    335E00000X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-99489-PROVIDER-DIRECTED-CLINICAL-STAFF-CARE-COORDINATION-COMPLEX-CHRONIC-CONDITIONS

    CPT 99489: Provider-Directed Clinical Staff Care Coordination

    CPT-99490-CHRONIC-CARE-MANAGEMENT-PROVIDER-DIRECTED-20-MIN

    CPT 99490: Chronic Care Management, Provider-Directed Clinical Staff

    CPT-99491-CHRONIC-CARE-MANAGEMENT-PHYSICIAN-PERSONAL-30-MIN

    CPT 99491: Chronic Care Management, First 30 Minutes Per Month

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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