(Last Updated On: March 1, 2019)
As of 2017, CPT 99487 is reimbursed by Medicare to account for extended care coordination time spent with especially complex patients. This code reimburses for the first 60 minutes of non-face-to-face care coordination by clinical staff. This contrasts with CPT 99490 which was introduced January 1st, 2015 which reimburses for only 20 minutes of care coordination time. CPT 99487 requires the following elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
- Chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline
- Establishment or substantial revision of a comprehensive care plan
- Moderate or high complexity medical decision making
- 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
The two key differentiators between 99487 and 99490 are the additional time (60 minutes for CPT 99487 from 20 minutes for CPT 99490) and the requirement around medical decision making. In addition, a code reimbursing for additional time (CPT 99489) is available for complex CCM patients being billed under CPT 99487.