Part of Chronic Care Management
CPT 99487: Complex CCM, first 60 minutes of clinical staff time
First 60 minutes per calendar month of complex chronic care management, distinguished from non-complex CCM by moderate-to-high complexity medical decision making and the higher time threshold, not by how extensively the care plan itself is revised that month.
Time threshold & code combinations
First 60 minutes of clinical staff time per calendar month, with moderate-to-high complexity medical decision making.
- 99489 is the add-on for each additional 30 minutes beyond this threshold
- Not billed alongside non-complex CCM (99490/99491) for the same patient and period
Who can bill
- Physicians and non-physician practitioners directing the clinical staff who furnish the service
Eligibility & billing requirements
- Two or more chronic conditions expected to last at least 12 months or until death, with significant risk as described in the program overview
- Moderate-to-high complexity medical decision making related to the patient's conditions during the month
- Documented patient consent
- Care plan is established, implemented, revised, or monitored during the month (a substantial rewrite of the plan is not required)
- 24/7 access and care coordination activity in place
When to use it
Care plan overhaul after a new diagnosis
A patient with existing diabetes and CKD is newly diagnosed with heart failure; staff spend 60 minutes revising the care plan and coordinating with a cardiologist, with moderate-to-high complexity decision making documented.
Billing: 99487
Documentation checklist
- Time log showing at least 60 minutes of clinical staff time
- Documentation supporting moderate-to-high complexity medical decision making
- Evidence the care plan was established, implemented, revised, or monitored during the month
Common billing mistakes
- Billing 99487 without medical decision making that actually supports moderate-to-high complexity (should be 99490 instead if MDM doesn't rise to that level)
- Assuming complex CCM requires a substantial rewrite of the care plan each month, monitoring or implementing the existing plan satisfies the care-planning element