Reimbursement
$144.29
Threshold
60m
2026 Status
Active
What is CPT Code 99487?
CPT 99487 is defined as: 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 place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; establishment or substantial revision of a comprehensive care plan; 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.
This code is primarily used for CCM services. It falls under the category of Care Management / Complex CCM and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
2.38
Physician Effort
PE (Non-Fac)
1.75
Practice Expense
Malpractice
0.19
Risk Factor
Total RVU
4.32
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (Time-based care management service).
high complexity premium
99487 pays significantly more ($103.54) than standard CCM ($61.96), rewarding the increased staff time and MDM complexity.
fqhc rhc transition
FQHCs must now itemize and bill 99487 for patients meeting complex CCM criteria to capture the true cost of care following G0511 sunset.
Administrative Framework
Operational Requirements
minimum time
60 minutes of cumulative clinical staff time per calendar month.
mdm level
Moderate or High Complexity Medical Decision Making (MDM) REQUIRED.
care plan
Establishment or SUBSTANTIAL revision of a comprehensive care plan.
frequency
Once per calendar month.
Compliance Checklist
Audit Defense
mdm evidence
Audit failure often occurs if the physician note does not demonstrate moderate/high complexity decision making (e.g., managing multiple systemic treatments).
distinct from setup
Time spent on the initial E/M visit cannot count toward the 60-minute staff management time.
2026 Update
A 'substantial revision' typically involves a change in treatment modality, adding new specialist coordination, or responding to a recent hospitalization.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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