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99487 CPT Code Description: Complex CCM and 99489
What makes a CCM month complex, how the time adds up, and what Medicare pays in 2026.
Short answer: The 99487 CPT code description covers complex chronic care management: at least 60 minutes of clinical staff time per calendar month plus moderate or high complexity medical decision making by the billing practitioner. The patient must meet CCM eligibility and care-plan requirements. Add 99489 for each additional 30 minutes (MLN909188).
Compared with 99490, the 99487 CPT code description raises the monthly time threshold from 20 to 60 minutes and requires moderate or high complexity medical decision making. The chronic-condition, risk and care-plan requirements stay the same (MLN909188, Tables 1 and 2).
The descriptors below are CMS restatements; the CPT wording is AMA copyright.
TL;DR: complex chronic care management in four lines
The codes: 99487 covers the first 60 minutes of clinical staff time in a complex month; 99489 adds each further 30.
What makes it complex: moderate or high complexity medical decision making by the billing practitioner.
The claim: reported at the end of the calendar month, not on the day the time is reached.
The main bars: never in the same month as 99490, 99439, 99491, 99437 or a prolonged E/M service for that patient.
The 99487 CPT code description, element by element
CMS restates 99487 as complex chronic care management with four required elements and a time unit (MLN909188, Tables 1 and 2; CMS CCM FAQ):
- Conditions: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient.
- Risk: the conditions place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline.
- Care plan: a comprehensive care plan established, implemented, revised or monitored.
- Decision making: moderate or high complexity medical decision making.
- Time: the first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
The first three elements are the same as for 99490 (MLN909188, Table 1).
The 99489 CPT code description: the complex add-on
99489 is each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, for complex CCM with the same decision making (CMS CCM FAQ; CY2022 final rule).
How many units of 99489 to report
| Monthly minutes | Report |
|---|---|
| 65 | 99487 |
| 95 | 99487 + one 99489 |
| 125 | 99487 + two 99489 |
99487 vs 99490: worked months for one patient
Five months for one patient show how the minutes and the billing practitioner’s decision making together pick the code. The minutes column counts clinical staff and practitioner time alike, except practitioner time used for CPT 99491 and its 99437 add-on, a pair that never shares a month with 99487 (MLN909188).
| Month | Minutes logged by clinical staff and the billing practitioner | Billing practitioner’s decision making | Codes reported |
|---|---|---|---|
| A | 45 | Moderate | 99490 and one 99439: below the 60-minute floor for 99487 |
| B | 65 | High | 99487 |
| C | 95 | Moderate | 99487 and one 99489 |
| D | 65 | Low | 99490 and two 99439: the same 65 minutes as month B, but low decision making keeps the month non-complex |
| E | 70 | High, with a prolonged E/M service billed that month | No 99487 or 99489 while the prolonged E/M service is billed (MLN909188); for the non-complex codes, check CPT instructions and your MAC |
How a CPT 99487 month works, from first minute to claim
Who can bill 99487, and whose time counts
- Who bills: a physician, nurse practitioner, physician assistant, clinical nurse specialist or certified nurse-midwife.
- Whose time counts: clinical staff and the billing practitioner; exclude minutes counted toward another billed code.
- Supervision: general supervision, meaning overall direction and control without requiring the practitioner to be physically present. Source: MLN909188.
When to bill 99487: at the end of the month
The service period is one calendar month (CMS CCM FAQ). A 99490 claim may go once its threshold is met, but complex CCM is reported at the end of the month (CMS CCM FAQ). Once a 99490 claim for the month is on file, 99487 cannot be reported for that patient in the same month (MLN909188); whether that claim can be corrected and replaced is a question for your MAC.
Medical decision making for 99487
- Who decides: the billing practitioner must perform the moderate or high complexity medical decision making; it cannot be subcontracted.
- What to record: the problems the practitioner addressed throughout the month determine the decision-making level. See CCM documentation requirements. Sources: MLN909188; CMS CCM FAQ.
When to bill 99490 instead of 99487
A month short of the complex level that clears 20 minutes and meets the 99490 elements can go under the 99490 CPT code and its 99439 add-on instead (MLN909188).
What cannot share a month with complex chronic care management
| Other service | Can it share the month with complex CCM? |
|---|---|
| 99490, 99439, 99491 or 99437 | No |
| Prolonged E/M | No |
| Home health/hospice supervision: G0181, G0182 | No |
| Certain ESRD services: 90951 to 90970 | No |
| PCM: 99424 to 99427; APCM: G0556 to G0558 | Not from the same practitioner |
| TCM | Yes; do not count any minute twice |
For rules by practitioner, see the CCM concurrent billing table.
Common 99487 billing mistakes
Three 99487 mistakes that cost a complex month:
Mistake: reading the care plan element as “substantially revised”. CMS’s restatement asks for a comprehensive care plan established, implemented, revised or monitored, the same element as 99490 (MLN909188; CY2022 final rule).
Mistake: starting CCM for a new patient without an initiating visit. New patients and patients not seen by the billing practitioner within the previous year need an initiating visit where CCM is discussed. A comprehensive face-to-face E/M visit (levels 2 to 5, 99212 to 99215), an annual wellness visit or an initial preventive physical exam qualifies. Patients seen within the year need no separate initiating visit (MLN909188; CMS CCM FAQ).
Mistake: billing complex CCM in a month another practitioner bills CCM. Only one practitioner can furnish and bill CCM for a patient in a calendar month, and the patient is told so before CCM starts (MLN909188).
Offer care management without adding staff
Companian does not support 99487, 99489, 99491 or 99437. For the staff-time codes, see chronic care management and principal care management.
Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.
Key takeaways
- Read the care plan element as established, implemented, revised or monitored: the same as 99490, not “substantially revised”.
- Make sure each complex month’s record shows the problems the billing practitioner addressed; staff minutes alone never make a month complex.
- For a month that may be complex, hold the claim until the month closes, then report complex or non-complex CCM for the patient, never both.
- Keep the complex-level decision making with the billing practitioner; CMS bars subcontracting it.
- Before billing 99487, check the month for a prolonged E/M service or another CCM code for the same patient.
Questions about CPT 99487 and 99489
What is the difference between 99490 and 99487?
99490 needs at least 20 minutes and no particular level of decision making, and can be claimed once the 20 minutes are reached; 99487 needs 60 minutes plus moderate or high complexity decision making by the billing practitioner, and is reported at month end. A patient can be billed under 99490 one month and 99487 the next, never both in the same month.
How many minutes are needed to bill 99487?
99487 needs at least 60 minutes of clinical staff time in the calendar month. Minutes the billing practitioner spends directly count toward the 60, but no minute already counted toward another billed code, such as a transitional care management service, can count again.
What is the difference between 99487 and 99489?
99487 is the base code for the first 60 minutes of clinical staff time in a complex CCM month. 99489 is the add-on for each further 30 minutes in that month.
Can complex CCM be billed in the same month as a prolonged E/M service?
No. CMS bars complex CCM and prolonged evaluation and management services in the same calendar month. For other codes that cannot be billed with CCM, CMS points to CPT instructions; confirm with your MAC.
Can a nurse practitioner bill 99487?
Yes. Nurse practitioners may bill CCM, as may physicians, physician assistants, clinical nurse specialists and certified nurse-midwives. The moderate or high complexity decision making must then be the billing nurse practitioner’s own.
Does a patient need new consent to move from 99490 to 99487?
CMS asks for CCM consent once, before CCM starts, and again only when the patient changes billing practitioner. Moving the patient from the non-complex to the complex codes under the same billing practitioner does not call for new consent. The usual Part B deductible and 20 percent coinsurance apply to the complex codes too, and the original consent already told the patient that cost sharing may apply.
Medicare Part B CCM, billed by physician practices, has three code pairs: clinical-staff CCM (99490, 99439), practitioner-furnished CCM (99491, 99437) and complex CCM (99487, 99489). A patient’s month uses one pair only. Companian does not support 99487, 99489, 99491 or 99437.
Sources
- CMS, Chronic Care Management Services (MLN909188), June 2025
- CMS, Frequently Asked Questions about Practitioner Billing for Chronic Care Management Services, August 2022
- CY 2022 Physician Fee Schedule final rule (86 FR 64996)
- CY 2025 Physician Fee Schedule final rule (89 FR 97710)
- CMS, MM14279, CY2026 Part B deductible and coinsurance
Read more: Principal care management for patients with one high-risk condition · Who refers and who bills: how Companian works with physicians
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