Category
Complex Chronic Care Management Services
CODE TYPE
Timed-based code
Billed in 30 minutes increment
Primary Code
99487
An add-on code for Complex chronic care management services for patients having 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. The services include establishment or substantial revision of a comprehensive care plan, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. The code 99489 is listed separately in addition to code for primary procedure.
CODING CRITERIA
For CPT 99489, 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 place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
- Comprehensive care plan established, implemented, revised, or monitored
- An add-on code for complex CCM service, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional
- Billed as per calendar month (List separately in addition to code for primary procedure)
BILLING GUIDELINES
Providers cannot bill more than one CCM claim for a patient per calendar month i.e. 30 days.
CODE FIRST
Always code first the primary code i.e 99487
