Updated for 2026. CPT 99487 is Medicare's primary code for Complex Chronic Care Management (Complex CCM) provided to eligible patients with multiple chronic conditions.
CMS identifies CPT 99487 as the first 60 minutes of qualifying clinical-staff Complex CCM services during a calendar month, directed by a physician or other qualified healthcare professional.
Complex CCM also requires moderate- or high-complexity medical decision-making by the physician or other billing practitioner. Reaching 60 minutes alone does not automatically support CPT 99487.
CPT 99487 at a Glance
RequirementCPT 99487ServiceComplex Chronic Care ManagementChronic conditions2 or more qualifying chronic conditionsExpected durationAt least 12 months or until deathInitial monthly timeFirst 60 minutesStaff modelClinical staff directed by physician or qualified healthcare professionalMedical decision-makingModerate or high complexity requiredAdd-on code99489Care planComprehensive patient-centered care plan
What Is CPT 99487?
CPT 99487 represents Complex Chronic Care Management for patients whose multiple chronic conditions require a higher level of care-management intensity.
CMS distinguishes Complex CCM from standard CCM through two major elements:
- A higher monthly care-management time requirement
- Moderate- or high-complexity medical decision-making by the billing practitioner
The service may involve extensive coordination across medications, specialists, caregivers, hospitals, community services, and other parts of the patient's care plan.
Who Qualifies for Complex CCM?
Like standard CCM, the patient generally must have two or more chronic conditions that are expected to last at least 12 months, or until the patient's death.
Those conditions must place the patient at significant risk of:
- Death
- Acute exacerbation
- Decompensation
- Functional decline
Complex CCM additionally requires documentation supporting moderate- or high-complexity medical decision-making.
How Much Time Is Required for CPT 99487?
CMS lists CPT 99487 as the first 60 minutes of clinical-staff Complex CCM time per calendar month.
The qualifying work may occur across multiple interactions throughout the month rather than during one continuous encounter.
Practices should maintain detailed records showing the activities contributing to the monthly total.
Moderate- or High-Complexity Medical Decision-Making Is Required
This is one of the most important differences between CPT 99487 and standard CCM.
CMS states that Complex CCM services require and include moderate- to high-complexity medical decision-making by the physician or other billing practitioner.
Therefore, 60 minutes of staff activity by itself does not establish that CPT 99487 is supported.
The record should demonstrate both:
- Qualifying Complex CCM time
- The required practitioner medical decision-making
What Activities May Contribute to CPT 99487?
Qualifying activities should relate to management of the patient's multiple chronic conditions and comprehensive care plan.
Medication Management
- Medication reconciliation
- Reviewing adherence problems
- Coordinating medication changes
- Identifying potential medication interactions
- Following up after hospitalization or specialist changes
Care-Plan Management
- Reviewing patient goals
- Updating interventions
- Revising the comprehensive care plan
- Responding to meaningful changes in clinical condition
Care Coordination
- Coordinating with multiple specialists
- Communicating with hospitals or post-acute facilities
- Managing clinically significant referrals
- Coordinating home-health or community resources
Patient and Caregiver Management
- Reviewing symptoms
- Addressing treatment barriers
- Discussing established management plans
- Coordinating caregiver involvement
- Escalating clinically important changes to the practitioner
Example CPT 99487 Patient
Consider a Medicare patient with:
- Heart failure
- Chronic kidney disease
- COPD
- Type 2 diabetes
During the month, the patient is discharged from the hospital with medication changes and worsening respiratory symptoms.
The CCM team performs medication reconciliation, communicates with cardiology and nephrology, follows up with the patient and caregiver, updates the comprehensive care plan, and coordinates post-discharge services.
The billing practitioner reviews the changing clinical picture and documents moderate-complexity medical decision-making.
If qualifying Complex CCM activity reaches the applicable 60-minute threshold and all other Medicare requirements are satisfied, CPT 99487 may be evaluated.
Example Monthly Complex CCM Time Record
DateActivityTimeOct 3Post-discharge medication reconciliation16 minOct 9Cardiology and nephrology care coordination14 minOct 15Patient and caregiver symptom follow-up12 minOct 21Comprehensive care-plan revision11 minOct 27Additional clinical coordination and follow-up10 minTotal qualifying time63 min
If the record also supports moderate- or high-complexity practitioner medical decision-making and all other CCM requirements, the billing team may evaluate CPT 99487.
What Is CPT 99489?
CPT 99489 is the add-on code associated with CPT 99487.
CMS's current CCM guidance lists CPT 99489 as each additional 30 minutes of qualifying Complex CCM clinical-staff time.
CodeComplex CCM Time99487First 60 minutes99489Each additional 30 minutes
CPT 99489 is an add-on code and should not be billed independently without the applicable base Complex CCM service.
CPT 99487 vs CPT 99490
FeatureCPT 99487CPT 99490ServiceComplex CCMStandard CCMInitial time60 minutes20 minutesModerate/high MDMRequiredNot a Complex CCM requirementAdd-on code9948999439
CMS does not allow standard and Complex CCM to be reported for the same patient during the same calendar month.
Can Practitioner Time Count Toward CPT 99487?
Yes. CMS states that CPT 99487, 99489, 99490, and 99439 may include qualifying time spent directly by the billing practitioner as well as qualifying clinical-staff time.
However, practitioner time counted toward CPT 99487 cannot also be counted toward CPT 99491 or another billed service when duplicate time reporting is prohibited.
Comprehensive Care Plan Requirements
CMS requires an appropriate comprehensive patient-centered care plan for both standard and Complex CCM.
The plan may include:
- Problem list
- Expected outcomes and prognosis
- Measurable treatment goals
- Cognitive and functional assessment
- Symptom management
- Planned interventions
- Medication management
- Environmental assessment
- Caregiver assessment
- Coordination with outside practitioners and resources
- Periodic review and revision
The care plan should reflect the patient's actual medical, functional, and psychosocial needs.
Patient Consent
Medicare requires informed consent before CCM services begin.
CMS allows consent to be verbal or written when appropriately documented.
Patients should be informed about:
- The availability of CCM services
- Possible cost sharing
- The fact that only one practitioner may furnish and bill CCM during a calendar month
- The patient's ability to discontinue CCM services
Initiating Visit
CMS requires an initiating visit before CCM begins for new patients or patients who have not been seen by the billing practitioner within the previous year.
The visit may be incorporated into an appropriate Evaluation and Management visit, Annual Wellness Visit, or Initial Preventive Physical Examination.
24/7 Access and Continuity
CMS identifies access and continuity of care as CCM service elements.
Practices should maintain systems that provide patients with appropriate 24/7 access for urgent care-management needs and a designated care-team relationship for routine chronic-condition management.
Can CPT 99487 and CPT 99490 Be Billed Together?
No. CMS states that non-complex CCM and Complex CCM cannot be reported for the same patient during the same calendar month.
The month's documented services should support one CCM pathway or the other.
Can CPT 99487 and CPT 99491 Be Billed Together?
CMS states that CPT 99491 and 99437 should not be reported in the same calendar month as CPT 99487, 99489, 99490, or 99439 for the same patient.
Practices should therefore maintain clear separation between practitioner-only CCM and clinical-staff Complex CCM workflows.
Can CPT 99487 Be Billed During TCM?
CMS allows CPT 99487, 99489, 99490, and 99491 to be reported for qualifying services furnished during the 30-day Transitional Care Management period when applicable requirements are met.
The same activity or time cannot be counted toward another billed service.
Can Complex CCM and RPM Be Furnished Together?
CMS permits either Remote Physiologic Monitoring or Remote Therapeutic Monitoring to be furnished concurrently with CCM when each service independently satisfies its requirements.
The same time cannot be used to support multiple time-based services.
Complex CCM Documentation Example
Example: Patient with CHF, CKD, COPD, and diabetes experienced worsening dyspnea following hospitalization. Clinical staff reconciled discharge medications, coordinated cardiology and nephrology recommendations, communicated with patient and caregiver regarding worsening symptoms, updated the comprehensive care plan, and arranged follow-up services. Total qualifying Complex CCM time: 64 minutes. Billing practitioner reviewed the patient's changing condition and documented moderate-complexity medical decision-making.
This type of documentation gives substantially more support than recording only: 99487 - 64 minutes.
Common CPT 99487 Billing Mistakes
1. Billing Based Only on 60 Minutes
Complex CCM also requires moderate- or high-complexity medical decision-making and the other applicable CCM requirements.
2. Missing Practitioner Medical Decision-Making
Clinical-staff time alone does not establish the required Complex CCM medical decision-making component.
3. Billing 99487 and 99490 Together
CMS does not allow standard and Complex CCM for the same patient during the same calendar month.
4. Missing the Comprehensive Care Plan
Complex CCM requires appropriate comprehensive care planning and ongoing management.
5. Counting Administrative or Waiting Time
Purely clerical activity or time waiting for a response should not automatically be included as qualifying CCM time.
6. Double Counting Time
The same minutes cannot be used to support another billed service when Medicare prohibits duplicate time reporting.
7. Billing 99489 Without 99487
CPT 99489 is an add-on code and requires the applicable base Complex CCM service.
CPT 99487 Pre-Billing Checklist
- Patient has at least two qualifying chronic conditions.
- Conditions meet the expected-duration requirement.
- Required clinical risk is documented.
- Initiating visit was completed when required.
- Patient consent is documented.
- A comprehensive patient-centered care plan is maintained.
- Qualifying Complex CCM activities are documented.
- At least the applicable 60-minute base time is supported.
- Moderate- or high-complexity medical decision-making is documented.
- Staff and practitioner identities are recorded.
- Additional qualifying time for 99489 is reviewed separately.
- Standard CCM is not reported for the same calendar month.
- Practitioner-only CCM is not improperly combined with Complex CCM.
- Duplicate time with RPM, RTM, TCM, or other services is reviewed.
- Current CMS, CPT, MAC, and payer requirements are verified.
How ChronicSync Can Help
Complex CCM often involves multiple chronic conditions, specialists, medication changes, caregiver communication, care-plan revisions, and many care-management activities throughout a month.
ChronicSync helps practices organize chronic-care workflows, maintain structured patient records, track staff activity, and improve visibility into ongoing care-management documentation.
A structured workflow can help billing teams determine whether a month supports standard CCM, Complex CCM, and any applicable additional care-management time before claim submission.
Start your ChronicSync Free Pilot and explore a more organized approach to Chronic Care Management.
Frequently Asked Questions
What is CPT 99487?
CPT 99487 represents the first 60 minutes of qualifying clinical-staff Complex Chronic Care Management during a calendar month.
Does CPT 99487 require medical decision-making?
Yes. CMS states that Complex CCM requires moderate- or high-complexity medical decision-making by the physician or other billing practitioner.
What is the add-on code for CPT 99487?
CPT 99489 is the add-on code and represents each additional 30 minutes of qualifying Complex CCM clinical-staff time under current CMS CCM guidance.
Can CPT 99487 and CPT 99490 be billed together?
No. CMS states that non-complex CCM and Complex CCM cannot be reported for the same patient during the same calendar month.
Can physician time count toward CPT 99487?
CMS states that qualifying billing-practitioner time may contribute toward CPT 99487 and 99489, provided the same time is not also used for another billed service such as CPT 99491.
Does CPT 99487 require two chronic conditions?
Yes. Complex CCM applies to patients with two or more qualifying chronic conditions expected to last at least 12 months or until death and that create significant clinical risk.
Can Complex CCM and RPM be billed in the same month?
CMS permits qualifying RPM or RTM concurrently with CCM when each service independently meets its requirements and the same time is not counted twice.
Sources
- CMS Medicare Learning Network: Chronic Care Management Services
- CMS: Chronic Care Management Frequently Asked Questions
- CMS Connected Care: Health Care Professional Toolkit
This article is provided for educational purposes only and does not constitute medical, legal, coding, reimbursement, compliance, or billing advice. CPT, Medicare, Medicare Administrative Contractor, and commercial-payer requirements can change. Verify current coding and payer requirements before submitting claims.