CPT 99487

Definition

CPT 99487 is the Medicare billing code for the first 60 minutes of clinical staff time spent on complex Chronic Care Management for a patient in a calendar month, reimbursed at approximately $144 and requiring substantial care plan revision for patients with moderate-to-high complexity medical decision-making. It is the complex CCM track — an alternative to non-complex CCM (CPT 99490) — and cannot be billed in the same month as the non-complex base code.

Like non-complex CCM, 99487 requires two or more chronic conditions expected to last at least 12 months and placing the patient at significant risk of death, exacerbation, or functional decline. However, complex CCM adds two further clinical requirements: moderate-to-high complexity medical decision-making AND substantial care plan revision during the billing month. The time threshold is 60 minutes of clinical staff time (compared to 20 minutes for CPT 99490). A patient is billed under the non-complex or the complex track in a given calendar month — never both. The 2026 Medicare national average reimbursement is approximately $144 per patient per month.

Regulatory basis

CPT 99487 is established by CMS under the Medicare Physician Fee Schedule as part of the CCM code family (99490, 99439, 99487, 99489). The authoritative guidance is the CMS MLN Chronic Care Management Services booklet (MLN 909188), which defines documentation requirements, consent standards, and time-tracking rules for both complex and non-complex CCM tracks.

The “moderate or high complexity medical decision-making” element follows CMS’s Evaluation and Management (E/M) decision-making framework. Substantial care plan revision must be documented in the patient chart with specifics— examples include medication changes, new specialist referrals, escalation of monitoring frequency, or changes to the care-management protocol driven by a worsening or newly identified condition. Annual updates to CCM billing policy are published in the Medicare Physician Fee Schedule final rule.

Who uses it and when it applies

• Physicians, non-physician practitioners (NPs, PAs, CNSs, CNMs), or clinical staff under general supervision performing complex CCM activities
• Patients meeting non-complex CCM eligibility AND requiring moderate-to-high complexity medical decision-making — typically those with unstable conditions, recent hospitalization, or significant care plan changes in the month
• Billed once per calendar month per patient when cumulative clinical staff time reaches 60 minutes and substantial care plan revision is documented
• A patient can shift between the non-complex (99490) and complex (99487) tracks across months as clinical complexity changes — only one track applies in any given month

Related terms

• CPT 99489 — each additional 30 minutes of complex CCM clinical staff time in the same calendar month
• CPT 99490 — alternative non-complex CCM track for lower-complexity patients, requiring 20 minutes per month
• Chronic Care Management — the broader care model CPT 99487 operationalizes for complex patients
• Care coordination — the function CCM supports through structured patient outreach and care-plan management

How Positive Check relates

Positive Check’s structured summaries help clinical staff document the substantial care-plan revisions and complexity-of-decision-making elements that distinguish complex from non-complex CCM, supporting accurate 99487 billing. See the Chronic Care Management solution for the full workflow, or the CPT 99490 billing guide for documentation and time-tracking requirements across the CCM code family.