What is CPT Code 99487?
CPT Code 99487 is the Medicare billing code for complex chronic care management services for patients with multiple chronic conditions. This code was established in to provide for the virtual monthly care of patients who require more time than the 20 minutes provided for by CPT Code 99490.
Who Qualifies for CPT Code 99487?
Patients qualify for complex chronic care management services if they have at least 2 chronic conditions that are:
- Expected to last at least 12 months (such as diabetes, high blood pressure, arthritis, cancer)
- Expected to place the patient at risk of serious harm, injury, or death, if not given regular appropriate treatment
What Services Are Required?
- At least an hour of clinical staff time per month
- Directed by a physician or nurse practitioner
- The creation of a comprehensive care plan or a substantial revision to an existing care plan
- Complex medical decision-making
When Should You Bill for CPT 99487?
It is not likely that patients would require complex chronic care management services on a monthly basis. However, these are likely situations where it might make sense:
- The first month of services for a patient with multiple chronic conditions. This time would be spent not just talking with the patient, but also pulling together all their information from their chart into a single plan of care.
- After a visit to the hospital. After a hospital visit, the patient will likely need substantial updates to their plan of care.
- After the onset of a new chronic condition. A new chronic condition means changes to medicines and lifestyle.
How Much Does Medicare Reimburse?
As of 2021, the average reimbursement for non-facility complex chronic care management services (CPT 99487) is $94.55.
Can CPT Code 99487 Be Billed With CPT Code 99490?
CPT Code 99490 is the base code for Chronic Care Management that can be billed for at least 20 minutes of services. If you bill for CPT Code 99490, you cannot bill for 99487.
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