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    OpenPayerBilling CodesComplex Chronic Care Management ServicesCPT cpt-99489-provider-directed-clinical-staff-care-coordination-complex-chronic-conditions
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    CPT 99489: Provider-Directed Clinical Staff Care Coordination

    Medicare pays $81 on average nationally for this procedure.

    CPT code 99489 describes additional provider-directed clinical staff time spent coordinating and supporting care for patients with two or more chronic conditions who are at significant risk of death, acute exacerbation, decompensation, or functional decline; this code is used for each additional 30 minutes beyond the first hour per calendar month and represents team-based care coordination services provided by clinical staff under physician or other qualified provider direction, typically occurring in outpatient clinic, care management, or telehealth-supported care coordination 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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 78-year-old man with long-standing congestive heart failure with reduced ejection fraction, chronic obstructive pulmonary disease, and stage 3 chronic kidney disease is enrolled in a provider-directed multidisciplinary care program. The primary care physician directs clinical staff (nurses, social workers, and pharmacists) to coordinate care across cardiology, pulmonology, nephrology, home health, and community-based services. During the calendar month the clinical staff perform initial intake, medication reconciliation, symptom assessments by telephone and secure messaging, coordination of an urgent cardiology visit, and communication with home health to arrange oxygen delivery. The provider documents that more than 60 minutes of clinical staff time was spent in total under the provider’s direction; an additional 30 minutes of team-based coordination beyond the first hour is billed using 99489 for that calendar month. Typical workflow steps include: initial assessment and care-plan updates by a nurse, pharmacist medication review and provider-directed recommendations, social worker addressing home safety and caregiver support, secure messaging documentation, and scheduled interdisciplinary case conference directed by the billing provider. Typical site of service is an outpatient clinic, home health setting, or telehealth/remote communication environment supporting care coordination for complex chronic conditions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99487Complex chronic care coordination services, with substantial care coordination (typically first 60 minutes of provider time per calendar month)Billed for the initial comprehensive provider-directed team care in the month; 99489 is used for each additional 30 minutes beyond the first hour
    99490Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar monthMay be billed for less complex longitudinal care; 99489 applies to more complex, high-risk patients requiring provider-directed team time beyond 99487/99490 thresholds
    99354Prolonged physician service in the office or other outpatient setting requiring direct patient contact, first hour (list separately in addition to the office visit)Prolonged face-to-face time by the provider may occur alongside team-based coordination, separate reporting rules apply
    99495Transitional care management services with moderate complexity (interactive communication within 2 days and face-to-face within 14 days)Transitional care activities often overlap with coordination efforts; sequencing and billing rules determine appropriate use
    99496Transitional care management services with high complexityHigher-complexity post-discharge care coordination that may be part of the multidisciplinary activities overseen by the provider
    G2064Chronic care management services, remote, for patients with multiple chronic conditions (HCPCS G-code)Remote chronic care management codes may be used in programmatic workflows that complement provider-directed team services such as those billed with 99489

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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.,…
    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…
    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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    2084N0402X
    133VN1004X
    101YA0400X
    101YP1600X
    111NR0200X
    207ZP0101X
    363LA2100X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    B18.2Chronic viral hepatitis C
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified
    E78.5Hyperlipidemia, unspecified
    E87.6Hypokalemia
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    G47.00Insomnia, unspecified
    I10Essential (primary) hypertension

    Showing 1–10 of 27

    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-99487-COMPLEX-CHRONIC-CARE-MANAGEMENT-FIRST-60-MINUTES

    CPT 99487: Complex Care Management for Multiple Chronic Conditions

    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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