How To Use CPT Code 99487

CPT 99487 refers to complex chronic care management services provided by clinical staff under the direction of a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99487.

1. What is CPT 99487?

CPT 99487 is a code used to report complex chronic care management services provided by clinical staff under the direction of a physician or other qualified healthcare professional. These services are intended for patients with multiple chronic conditions that place them at significant risk of death, acute exacerbation, decompensation, or functional decline. The code is used for the first 60 minutes of provider-directed clinical staff time per calendar month.

2. 99487 CPT code description

The official description of CPT code 99487 is: Complex chronic care management services with the following required 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, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.

3. Procedure

1. Identify patients with multiple chronic conditions that place them at significant risk of death, acute exacerbation, decompensation, or functional decline.
2. Establish, implement, revise, or monitor a comprehensive care plan for the patient.
3. Ensure that the clinical staff provides services under the direction of a physician or other qualified healthcare professional.
4. Document the clinical staff’s time spent on care management services, including communication with the patient, caretakers, and other professionals, data collection, assessment and support of self-management, medication management, identification and assistance with community and health resources, care transitions management, patient status review, and care plan development and maintenance.
5. Bill CPT 99487 for the first 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month.

4. Qualifying circumstances

Patients eligible to receive CPT code 99487 services must have two or more chronic conditions that are expected to last at least 12 months or until the patient’s death. These chronic conditions must place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline. Additionally, the patient’s case must require moderate or high complexity medical decision making.

5. When to use CPT code 99487

It is appropriate to bill the 99487 CPT code when the clinical staff provides complex chronic care management services for a patient with multiple chronic conditions under the direction of a physician or other qualified healthcare professional. The code should be used for the first 60 minutes of provider-directed clinical staff time per calendar month. If the total duration of staff care management services is less than 60 minutes in a calendar month, it should not be reported separately.

6. Documentation requirements

To support a claim for CPT 99487, the following information must be documented:

• Patient’s multiple chronic conditions and their expected duration.
• Significant risk factors associated with the patient’s chronic conditions.
• Comprehensive care plan establishment, implementation, revision, or monitoring.
• Moderate or high complexity medical decision making.
• First 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month.

7. Billing guidelines

When billing for CPT code 99487, ensure that the patient meets the eligibility criteria and that the required elements are documented. Remember that the code is used for the first 60 minutes of provider-directed clinical staff time per calendar month. For each additional 30 minutes, use the add-on code +99489. Complex chronic care management services of less than 60 minutes duration in a calendar month should not be reported separately.

8. Historical information

CPT 99487 was added to the Current Procedural Terminology system on January 1, 2013. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2022.

9. Similar codes to CPT 99487

Five similar codes to CPT 99487 include:

• CPT 99489: Add-on code for each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.
• CPT 99490: Chronic care management services for patients with at least two chronic conditions, requiring at least 20 minutes of clinical staff time per month.
• CPT 99491: Chronic care management services provided personally by a physician or other qualified healthcare professional for at least 30 minutes per month.
• CPT 99492: Principal care management services for patients with a single high-risk condition, requiring at least 30 minutes of clinical staff time per month.
• CPT 99493: Principal care management services provided personally by a physician or other qualified healthcare professional for at least 30 minutes per month.

10. Examples

Here are 10 detailed examples of CPT code 99487 procedures:

1. A patient with congestive heart failure and diabetes requiring complex care management services, including medication management, care coordination, and monitoring of vital signs.
2. A patient with chronic obstructive pulmonary disease (COPD) and hypertension requiring care plan development, communication with specialists, and monitoring of medication adherence.
3. A patient with end-stage renal disease and peripheral artery disease requiring care transitions management, coordination with dialysis centers, and monitoring of lab results.
4. A patient with multiple sclerosis and depression requiring care plan revision, coordination with mental health providers, and monitoring of symptom progression.
5. A patient with Parkinson’s disease and osteoporosis requiring care plan implementation, coordination with physical therapists, and monitoring of fall risk.
6. A patient with rheumatoid arthritis and chronic pain requiring care plan monitoring, coordination with pain management specialists, and assessment of self-management strategies.
7. A patient with cancer and chronic fatigue syndrome requiring care plan establishment, coordination with oncologists, and monitoring of treatment side effects.
8. A patient with HIV and hepatitis C requiring care plan revision, coordination with infectious disease specialists, and monitoring of medication interactions.
9. A patient with dementia and atrial fibrillation requiring care plan implementation, coordination with neurologists and cardiologists, and monitoring of cognitive decline.
10. A patient with lupus and chronic kidney disease requiring care plan monitoring, coordination with nephrologists, and assessment of treatment effectiveness.