CPT 99487E&M

Cplx chrnc care 1st 60 min

CPT 99487 covers the first 60 minutes of complex chronic care management services provided to patients with multiple serious long-term conditions. This is a monthly service that coordinates care for patients requiring intensive management of conditions like diabetes, heart failure, and COPD.

Showing rates for

National Average

Base Medicare rate

$131.65

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.81

PE RVU (NF)

2.13

MP RVU

0.13

Total RVU

4.07

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact time spent by clinical staff in increments, including phone calls, care plan updates, medication reconciliation, and care coordination activities. Maintain detailed time logs.
Impact: Prevents denials for insufficient documentation; missing time logs account for 40% of CCM denials and result in $131.65 loss per claim
Obtain and document written or verbal consent from patient or caregiver before initiating CCM services, including discussion of cost-sharing responsibilities.
Impact: Required by CMS; missing consent results in automatic denial and $131.65 loss plus potential audit penalties
Only bill once per calendar month per patient; if you provide 60+ minutes in month 1, you cannot bill again until month 2. Track billing cycles carefully.
Impact: Duplicate monthly billing triggers Medicare system edits and 100% denial; proper tracking prevents $131.65 overpayment recovery
Verify patient has not received CCM services from another provider in the same month. Only one provider can bill per beneficiary per month.
Impact: Medicare allows only one CCM billing per patient monthly; coordination failures result in $131.65 denial and potential recoupment
Use add-on code 99489 for each additional 30 minutes beyond the first 60 minutes in same calendar month to maximize reimbursement for high-complexity patients.
Impact: Captures additional $64.47 per 30-minute increment; failing to bill add-on codes leaves significant revenue uncaptured for time-intensive patients
Ensure comprehensive care plan is documented and shared with patient/caregiver electronically or via paper; update at least annually or when patient condition changes significantly.

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Frequently asked questions

How much does Medicare pay for CPT 99487 in 2025?

Medicare pays $131.65 for CPT 99487 in non-facility settings and $87.01 in facility settings under the 2025 Physician Fee Schedule. This represents the national average payment rate; actual reimbursement may vary slightly based on geographic adjustment factors in your locality.

How many minutes are required to bill CPT 99487?

CPT 99487 requires a minimum of 60 minutes of clinical staff time per calendar month directed by a physician or qualified healthcare professional. Time must be spent on qualifying care management activities such as care planning, medication reconciliation, care coordination, and patient communication. The time does not need to be consecutive and accumulates throughout the calendar month.

Can CPT 99487 and 99490 be billed together?

No, CPT 99487 and 99490 cannot be billed together in the same calendar month for the same patient. Code 99490 is for non-complex chronic care management (20+ minutes), while 99487 is for complex chronic care management (60+ minutes). Choose the code that matches the complexity level and time spent. Bill 99487 for patients meeting complexity criteria with 60+ minutes of time.

What is the RVU value for CPT code 99487?

CPT 99487 has a total RVU of 4.07 for 2025, consisting of 1.81 work RVU, 2.13 practice expense RVU (non-facility), 0.75 practice expense RVU (facility), and 0.13 malpractice RVU. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare payment rates of $131.65 non-facility and $87.01 facility.

Do I need patient consent to bill CPT 99487?

Yes, CMS requires documented patient consent before initiating and billing for chronic care management services including CPT 99487. The consent must be obtained before the first billable CCM service and must include informing the patient about the services provided, cost-sharing responsibility, and their right to stop services at any time. Consent can be documented as written or verbal.

What chronic conditions qualify for CPT 99487?

CPT 99487 requires patients to have two or more chronic conditions expected to last at least 12 months or until death and that place the patient at significant risk of death, acute exacerbation, or functional decline. Qualifying conditions include diabetes, heart failure, COPD, chronic kidney disease, coronary artery disease, dementia, depression, hypertension with complications, and similar serious long-term illnesses requiring ongoing management.

Can nurse practitioners bill CPT 99487?

Yes, nurse practitioners and physician assistants can bill CPT 99487 as qualified healthcare professionals under Medicare's incident-to rules or under their own NPI if state law permits. The clinical staff time (60+ minutes) must be directed by the NP/PA or physician, and the NP/PA must oversee the care plan and maintain overall responsibility for care management. Payment rates are the same regardless of whether billed by MD, DO, NP, or PA.