CPT-99487

COMPLEX CHRONIC CARE MANAGEMENT

A primary code for Complex chronic care management services, multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. These chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services include establishment or substantial revision of a comprehensive care plan, moderate or high complexity medical decision making and 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

CODING CRITERIA

For CPT 99487, the following criteria should be met:

• Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
• Chronic conditions that lead to the risk of death, acute exacerbation/decompensation, or functional decline of patient
• Comprehensive care plan established, implemented, revised, or monitored
• Moderate or high complexity medical decision making
• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
• Billed once a month

BILLING CRITERIA

Providers cannot bill more than one CCM claim for a patient per calendar month i.e. 30 days

ADD ON CODE:

In case of service provided for more than the first 60 minutes, CPT code 99487 requires to add on code 99489 for each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)