Complex Chronic Care Management (CCCM) CPT Codes 2024

As per the Medicare Physicians Fee Schedule (MPFS), the Complex Chronic Care Management (CCCM) CPT codes 99487 and 99489 are classified as general supervision codes. The billing practitioner will oversee and direct all qualified care providers or healthcare professionals providing the service, without needing to be there in-person.

CCCM covers primary codes for two or more chronic diseases (like diabetes, hypertension, cancer) that are expected to remain for at least a year with acute exacerbation, body’s functional decline, or until the death of the patient. Complex CCM care services include creating or revising a comprehensive care plan, making moderate-to-high-complexity medical decisions, and having a doctor or a nurse practitioner direct or supervise the clinical staff for 60 minutes each calendar month.

All About CCCM CPT Code 99487 & Add-on Code 99489

Medicare started reimbursing CPT 99487 in 2017 to cover the additional time needed for care coordination when dealing with chronically ill patients. The first 60 minutes of non-face-to-face care coordination by clinical professionals are covered under this code.

If a doctor or other qualified health care provider provides care for longer than the first 60 minutes, CPT code 99487 requires add-on code 99489 for every additional  30 minutes each calendar month.

What Is CPT Code 99487?

For patients with two or more  chronic diseases, the Medicare billing code for Complex Chronic Care Management (CCCM) services is 99487. This code was created to cover patients who need longer care time than the 20 minutes of virtual monthly care covered under CPT Code 99490.

The eligibility criteria for CPT Code 99487 include:

• a patient has at least two chronic conditions expected to last for a minimum of 12 months (diabetes, hypertension, rheumatoid arthritis, cancer)
• chronic conditions that put the patient at risk for severe harm, injury, or even death in absence of regular and proper care

Coding Criteria For 99487

The following requirements must be satisfied to meet the coding criteria for CPT 99487:

• A thorough care plan that is created, carried out, updated, or tracked
• Making moderately or highly complicated medical decisions
• A doctor or other competent healthcare professional to oversee 60 minutes of clinical staff time
• Billed once each calendar month

When Can You Bill For 99487?

Complex chronic care management services are unlikely to be needed by patients on a monthly basis, unless they are severely ill and need constant monitoring. The following scenarios are ideal for billing 99487:

• a patient with multiple chronic diseases who need a personalized care plan.
• a patient’s treatment plan that require significant revisions following a hospital stay.
• a patient needing medicine and lifestyle adjustments after symptoms of a new chronic illness.

What Services Are Required For Reimbursement?

In 2024, the average reimbursement for non-facility CCCM CPT Code 99487 is $132. To qualify for reimbursement, the following must be completed:

• A minimum of an hour of clinical staff time every 30 days
• Care advice by a physician or nurse practitioner
• Comprehensive care plan or revision to an existing care plan
• Complex medical decision-making

Healthcare providers cannot bill for more than one CCCM claim for a patient every calendar month.

What Is CPT Code 99489?

For patients with multiple chronic diseases, CPT Code 99489 is an add-on code to CPT 99487 and used for Complex Chronic Care Management (CCCM) services. This code reimburses doctors or clinicians for the additional time they need to provide treatment and advice to patients’ in complex care scenarios.

If a patient has at least two chronic conditions, they are eligible for complex chronic care management services:

• expected to persist for a minimum of 12 months
• expected to put the patient at risk for severe harm, injury, or even death if proper care is not received

What Services Are Required For Reimbursement?

To bill for CPT 99489, you must comply with the following conditions:

• A minimum of thirty minutes per month for clinical staff time
• Directed by a qualified physician or nurse practitioner
• A thorough care plan being created or combined from an existing care plan
• Complex medical decision-making

To bill 99487 and 99489 in the same month, a total of 90 minutes (60+30) needs to be spent on caring for the patient under CCCM.

Complex chronic care management services (CPT 99489) average reimbursement is $71 in 2024.

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We have a suite of FDA-approved remote monitoring devices, clinical software, physicians’ dashboard, and billing capabilities set up to deliver accurate and efficient CCCM services.

HealthArc is your dependable choice for improving patient outcomes and reimbursement management. Our Chronic Care Management (CCM) software is intended to simplify patient monitoring and management while scaling your healthcare outcomes.

Please request a free demo to learn about how we can help your organization achieve its care coordination goals. Feel free to talk to our team at +201 885 5571 for any queries about the CCCM codes.