What is CPT Code 99489?

CPT Code 99489 is an add-on code to CPT 99487 used for Complex Chronic Care Management services for patients with multiple chronic conditions. It was established to reimburse physicians for the extra time it takes to coordinate care for patients in complex care situations.

Who Qualifies?

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?

In order to bill for CPT 99489, you must have already fulfilled the requirements for CPT 99487:

  • 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

In addition to these services, you must have spent an additional 30 minutes of the same services, for a total of an hour and a half of complex chronic care management services.

Are There Any Billing Limitations for CPT Code 99489?

  • CPT 99489 can only be billed as an add-on code to CPT 99497, never alone
  • It cannot be billed with CPT 99490 – basic chronic care management (the 30-minute add-on code for 99490 is 99491)

How Much Does Medicare Reimburse?

As of 2021, the average reimbursement for non-facility complex chronic care management services (CPT 99489) is $94.55.

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