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Complex Chronic Care Management - CPT 99487

Complex chronic care management (CCCM) aids patients in effectively managing multiple chronic conditions by bridging the communication gap with clinicians. Additionally, it enables healthcare providers to optimize reimbursements and enhance practice revenue.

CCCM entails managing two or more chronic conditions with intricate decision-making and longer billing thresholds compared to chronic care management (CCM). Services encompass crafting or revising a comprehensive care plan, making moderate-to-high-complexity medical decisions, and overseeing clinical sessions by a physician or nurse practitioner for 60 minutes each month under CPT Code 99487 and CPT Code 99489.

CCCM becomes necessary when a chronically ill patient exhibits:

  • The need for coordinating numerous health services

  • Difficulty performing daily living activities, leading to poor treatment adherence

  • Psychiatric and other medical comorbidities complicating their care

  • Requirements for access to care and social support

Understanding CPT Code 99487

CPT Code 99487 serves as the Medicare billing code for Complex Chronic Care Management (CCCM) services provided to patients with two or more chronic illnesses. This code supplements the 20 minutes of virtual care covered monthly under CPT Code 99490. Medicare reimburses CPT 99487 to cover the additional time required for providing care coordination services to patients with chronic conditions, encompassing the first 60 minutes of non-face-to-face care coordination by physicians and healthcare providers.

Eligibility Criteria for CPT Code 99487

To qualify for CPT Code 99487, patients must meet the following criteria:

possession of at least two chronic illnesses requiring moderate to high complexity of decision making, expected to last for at least 12 months, chronic conditions posing a risk of serious harm, injury, or death if not regularly treated, creation, implementation, updating, or tracking of a comprehensive care plan, making moderately to highly complicated medical decisions, 60 minutes of clinical staff time overseen by a doctor, physician, or nurse practitioner, billing limited to once per calendar month.

Billing Considerations for CCCM CPT Code 99487

Patients seldom require complex chronic care management services monthly, except when critically ill and necessitating ongoing monitoring. Billing for CPT Code 99487 is appropriate under the following circumstances:

  • Patients with several chronic conditions requiring specific treatment plans

  • Patients needing significant changes to treatment plans post-hospitalization

  • Patients requiring medication and lifestyle adjustments following chronic illness

Billing CPT Code 99487 Alongside CPT Code 99490

CPT Code 99490 serves as the baseline code for Chronic Care Management, covering at least 20 minutes of CCCM services. Billing for CPT Code 99490 precludes billing for 99487. Providers can only bill for one CCCM claim per patient per calendar month.

Required Services for Reimbursement

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

  • A minimum of one hour of clinical staff time every 30 days

  • Guidance from a physician or nurse practitioner

  • A comprehensive care plan or modification of an existing plan

  • Complex medical decision-making

Offer Chronic Care Management To Your Patients With ChronicCare

ChronicCare partners with Physicians, Hospitals, Payors, and Employers to offer Chronic Care Management Services to their patients. We are dedicated to helping people improve their health and quality of life by maximizing their healthcare outcomes. We bridge the gap between healthcare visits, in order to ensure patients are continually cared for each month. 

Click here to connect with our team, we'd love to discuss potential benefits to your patients, staff, and practice.

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