99487

Complex Chronic Care Management Services, First 60 Minutes

99487 represents complex chronic care management (CCM) services, which are a specialized subset of non-face-to-face evaluation and management services provided to patients with multiple high-risk chronic conditions. To accurately report this code, the billing practitioner must ensure the patient has at least two or more chronic conditions that are expected to persist for at least 12 months or until the patient's death. These conditions must place the patient at a significant risk of death, acute exacerbation, or functional decline. Unlike standard CCM (represented by 99490), complex CCM (99487) necessitates medical decision making of moderate or high complexity. Furthermore, it requires either the establishment of a brand-new comprehensive care plan or a substantial revision of an existing one. The service is defined by 60 minutes of clinical staff time performed under the direction of a physician or other qualified health care professional during a calendar month. The scope of these services is broad, encompassing systematic assessment of the patient's medical and psychosocial needs, coordination with various specialty providers, management of transitions of care, such as following a hospital discharge, and ensuring the patient has 24/7 access to the care team for any urgent health concerns. This service is designed to support patients who require more intensive coordination than standard CCM provides. The documentation must clearly state the time spent by staff, the specific nature of the care coordination, the complexity of the medical decision-making process, and the details regarding the care plan's status. It is a critical component for managing medically fragile populations and reducing readmission rates by providing continuous oversight and resource management for individuals with multi-system diseases.

Clinical Indications

  • Two or more chronic conditions expected to last 12 months or until death
  • Significant risk of death, acute exacerbation, or functional decline
  • Need for moderate or high complexity medical decision making
  • Requirement for substantial care plan revision or creation
  • Patient requires intensive coordination of care across multiple specialties

Procedure Steps

  1. Obtain and document patient consent for chronic care management services
  2. Perform a systematic assessment of the patient's medical, functional, and psychosocial needs
  3. Establish or substantially revise a comprehensive, electronic care plan based on all health issues
  4. Direct clinical staff in the management of the patient's care goals and interventions
  5. Coordinate care with external providers, community services, and specialists
  6. Manage transitions of care, including follow-up after hospital or SNF discharge
  7. Ensure the patient has 24/7 access to the care team for urgent needs
  8. Document at least 60 minutes of clinical staff time per calendar month

Coding Guidelines

  • Report 99487 for the first 60 minutes of complex CCM clinical staff time per calendar month
  • Use 99489 as an add-on code for each additional 30 minutes of clinical staff time
  • Moderate or high complexity medical decision making is required for 99487
  • Only one practitioner may report CCM services for a patient in a single calendar month
  • Do not report 99487 in the same month as 99490, 99491, or 99437
  • Clinical staff time includes only the time spent on the management of the patient, not administrative tasks
  • Documentation must include the dynamic comprehensive care plan and total time spent

Associated ICD-10 Codes