CPT 99489 vs. 99487: What Providers Should Know

test Effective chronic care management has become crucial in the U.S, as more patients live with multiple long-term conditions. It has been reported that approximately 129 million individuals in the country are affected by at least one major chronic illness. This has ramped up the clinical work performed outside of office visits.

As compensation for clinical work performed outside office visits, Medicare and the CPT code set include time-based billing for these services. Complex chronic care-related codes, specifically CPT 99487 and the add-on CPT 99489, reimburse clinically supervised, non-face-to-face care-team activities that support a patient’s comprehensive care plan.

This article explains the definitions, clinical and billing requirements, and practical documentation expectations for CPT 99487 and CPT 99489. You will find verified requirements, examples of appropriate use, and actionable documentation and compliance guidance.

What Are Chronic Care Management Codes?

Managing chronic care designates services that coordinate care for patients with two or more chronic conditions expected to last at least 12 months (or until the patient’s death) and that place the patient at significant risk of deterioration.

Codes for managing chronic care reimburse the time an interdisciplinary care team spends managing these patients outside of face-to-face visits. The Centers for Medicare & Medicaid Services (CMS) provides official guidance and definitions for the complex chronic care codes and their time requirements.

Key points that apply to codes concerning complex chronic care delivery:

• Services are reported per calendar month.
• Time-based codes describe cumulative clinical staff time directed by a physician or other qualified health professional.

CPT 99487: The Base Code for Complex Chronic Care

CPT 99487 represents the initial complex chronic care service for a patient within a calendar month. It reports the first 60 minutes of clinical staff time (under physician or QHP direction) devoted to complex care management. This time is non-face-to-face and may include care plan development, medication reconciliation, chart review, and coordination with other clinicians.

Clinical and coding requirements that must be met to bill 99487 are as follows:

• The patient has ≥2 chronic conditions expected to last ≥12 months (or until death), which places the patient at risk of death or functional decline.
• The service involves moderate or high complexity medical decision-making. This means clinical judgment beyond routine, including consideration of multiple management options and care plan adjustments.
• A comprehensive care plan must be established, documented, and shared with the patient and caregivers as appropriate.
• At least 60 minutes of qualifying clinical staff time directed by the physician or QHP must be documented during the calendar month. Time may be cumulative across multiple activities.

Practical Example

A primary care team documents 60 minutes in a month for chart review, medication reconciliation with the pharmacist, and outreach to a cardiologist after a medication change. The visit-independent care plan is updated and stored in the record. Billing 99487 is appropriate when the time threshold and other requirements are satisfied.

CPT 99489: The Add-On Code

CPT 99489 is an add-on code associated with 99487. It is reported for each additional 30 minutes of qualifying clinical staff time within the same calendar month beyond the initial 60 minutes reported with 99487. It cannot be billed alone.

The documentation expectations are as follows:

• Record discrete time entries that sum to the additional 30-minute increments (date, start/end or duration, activity performed).
• Ensure all additional time is in the same calendar month as the 99487 claim.
• Maintain a clear linkage between the extra time and the same comprehensive care plan and medical decision-making supporting the base service.

Practical Example

After billing 99487 for an initial 60 minutes, the care team documents two additional 30-minute blocks later that month for complex medication adjustments and coordination with a specialty infusion clinic. The provider would append 99489 once for each attributable 30-minute block.

Key Differences Between CPT 99487 & 99489

While both codes fall under the domain of complex chronic care management, they cover different time frames and billing scenarios. Here’s how they compare:

 

Understanding these differences ensures accurate chronic care billing and helps avoid claim denials. Providers should train their staff to track cumulative time correctly and use templates within their EHR to document care activities.

Documentation & Compliance Tips for Practices

Good documentation is what supports every successful chronic care claim. CMS requires clear proof of time spent, work done, and the impact on patient care.

Here are some useful practices to follow:

• Use time logs that capture date, start/end times or duration, staff role, and task description for each chronic care activity. Aggregate monthly totals when preparing claims.
• Store an explicit care plan in the chart that documents problems, goals, interventions, and parties responsible. Version and date each revision.
• Record clinical decision-making that demonstrates moderate or high complexity for 99487.
• Assign roles by identifying the billing clinician who directed the services, and confirm that each patient has a single monthly biller.
• Audit routinely through sample charts to ensure time entries and care plans support billed codes before claim submission.

These steps reduce denials and build an audit trail that aligns with CMS expectations.

Lessons for Practices Delivering Chronic Care

Given the rising prevalence of multiple chronic conditions and persistent underutilization of chronic care management, practices that establish effective workflows, clear role assignments, and reliable time capture can both improve patient continuity and capture legitimate revenue.

Adhering to the documentation steps above makes claims defensible and supports sustainable care for patients with complex needs. When practices apply precise coding and structured care protocols, they not only protect reimbursement but also elevate the impact of chronic care management services for patients who need them most.

FAQs

Will Medicare beneficiaries owe coinsurance for chronic care claims?

Yes. Chronic care services billed under Medicare Part B are subject to the Part B deductible and the beneficiary’s coinsurance, which is generally 20% of the Medicare-approved amount.

Is patient consent for chronic care management (CCM) billable, and how often must it be obtained?

Consent (written or verbal) must be obtained and documented before delivering chronic care, but obtaining consent is not separately billable.

Can practices bill chronic care together with Transitional Care Management (TCM) or with Remote Physiologic Monitoring (RPM)?

Yes. CMS allows chronic care to be reported alongside TCM or RPM when each service’s requirements are independently met and the time/activities are not double-counted.

Which clinicians or sites may bill complex chronic care delivery (99487/99489)?

Medicare allows physicians and certain non-physician practitioners (e.g., NPs, PAs, CNMs, CNS), as well as designated entities such as RHCs/FQHCs, to bill for CCM when they meet CMS requirements and direct the clinical staff’s work.

Do commercial insurers pay for chronic care delivery?

Many commercial and Medicare Advantage plans reimburse chronic care services. However, coverage, payment rates, and enrollment rules vary by payer.