Effectively dealing with medicare patients who are already going through various chronic conditions needs more than just checking in. It needs crucial and consistent attention, high-end coordination, clinical checkups, and multidisciplinary collaboration. CPT Code 99487 is the core for this level of care, designed to reimburse providers for delivering a well-structured, complex chronic care management to patients having high medical needs.
Here, at RPM& CCM Health, we adapt to practices that are scalable, compliant solutions for billing and delivering CCM services, especially when caring for the most important and medically complicated population. This page assists you with a clear overview of the CPT 99487, billing criteria, eligible activities, and how our platforms perfectly align with your care coordination workflows.
What Is CPT 99487?
To put this in perspective, CPT Code 99487 is a medicare billing code that is used for intricate CCM services that require 60 minutes or more of non-face-to-face time as per calendar month. This code is eligible for patients who are dealing with two or more chronic conditions, and are expected to last for at least 12 months.
Conditions that place the patient at risk of functional decline, hospitalization, or even death.
This CCM 60-minute billing code also requires that the patient’s care should be characterized with moderate or high-complexity medical decision-making, as well as an ongoing care plan managed by the clinical team. Certain activities must be conducted under the supervision of a qualified provider.
As a part of the chronic care management CPT codes, CPT 99487 is known to deal with all sorts of intensive work that involves managing medically complex patients.
Key Billing Requirements for CPT Code 99487
To bill CPT 99487 Medicare properly, some of the practices must meet a series of clinical and operational needs, which include:
- At least 60 minutes of documented non-face-to-face services performed by clinical staff
- Services delivered under the general supervision of a physician or advanced practitioner
- A comprehensive care plan that is created, reviewed, and modified as necessary
- Documentation that reflects moderate or high-complexity medical decision-making
- Patient consent for CCM services is documented prior to billing
- 99487 cannot be billed in the same month as codes 99490 or 99491
By following the 99487 billing guideline, you are making sure that all claims are accepted and that care documentation supports reimbursement.
Eligible Services That Qualify
These are categorized under the radar of care coordination services for complex patients, reinforcing the need for a more proactive and care-oriented approach.
Several types of care coordination tasks qualify toward the 60-minute threshold for CPT 99487, especially when managing complex patient cases. Examples include:
- Managing complex medication regimens and reconciliation
- Frequent coordination with multiple specialists
- Ongoing review and adjustment of dynamic care plans
- Interventions to address social determinants of health, such as transportation, food insecurity, or housing
- Follow-up and support after recent hospitalizations or ER visits
Medicare Reimbursement for CPT 99487
CPT 99487 reimburses depend on the region and payer; the figure reflects the high level of clinical involvement and the time taken for managing complex CCM populations. As for the providers, they should note that the regional Medicare Administrative Contractors may apply certain variations in reimbursement. Understanding the nuances of CPT 99487 Medicare reimbursement is key to optimizing both compliance and revenue capture.
Documentation Checklist
By following the guide below, this document process ensures that your team is always ready for a compliance review under this Medicare complex CCM code. Use this checklist as a guide.
- Time-tracked logs showing 60+ minutes of staff activity
- Names and roles of the clinical staff involved
- A dynamic care plan updated throughout the month
- Provider notes outlining clinical complexity and decision-making
- Written or verbal patient consent with follow-up communication documented
How RPM & CCM Health Simplifies Complex CCM
We know how exhausting it gets by the end of the day to manage complex chronic care patients; that’s where RPM & CCPM Health steps in, offering an EHR-integrated CCM program that aligns, intending to share the workload while you keep fully compliant.
We provide:
- Credentialed clinical staff to handle care coordination
- Integrated time tracking and documentation tools
- Seamless connection with your EHR for automated workflows
- Monthly reporting and transparent metrics for your patients and billing
- A dedicated coordination team that scales with your patient population
Schedule a Consultation today and let’s design a custom, complex CCM solution for your practice.
Other Related Chronic Care Management Codes
Explore more space of time-based CCM billing to optimize your care delivery model:
- CPT 99489 – For each additional 30 minutes of complex CCM
- CPT 99490 – For standard (non-complex) chronic care management
- CPT 99439 – Add-on for additional time with non-complex CCM
- Chronic Care Management Overview – Learn how these codes work together to improve care and revenue
Frequently Asked Questions About CPT Code 99487
What makes a patient eligible for CPT 99487?
The patient must have two or more chronic conditions and require moderate or high medical decision-making. The conditions must be expected to last at least 12 months.
Can CPT 99487 be billed with RPM services?
Yes, 99487 can be billed alongside remote patient monitoring (RPM) codes, provided all requirements for each service are independently met.
How is complex CCM different from regular CCM (99490)?
CPT 99487 includes more intensive care coordination, complex decision-making, and a minimum of 60 minutes. CPT 99490 requires only 20 minutes and does not require complex decision-making.
Can CPT 99487 be billed more than once a month?
No, CPT 99487 is limited to once per calendar month per patient. For additional time, use CPT 99489.
Who can perform the services under CPT 99487?
Clinical staff working under the general supervision of a physician or qualified healthcare professional may perform eligible services.
Ready to Deliver Scalable, Compliant, Complex CCM?
CPT Code 99487 gives your practice a solid tool to support your high-risk patients with utmost ease, and with RPM & CCM Health, you don’t have to do it all alone. Book a demo now and see how we make the process much easier for your complex CCM workflows, from documentation to reimbursement.
