2025 CPT code 99487
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Care Management Services Feed
Complex chronic care management services: at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, for patients with multiple (two or more) chronic conditions.
Modifier 25 may be appended to an E/M service provided on the same day as 99487 if the E/M service is significant and separately identifiable.
The patient must have two or more chronic conditions expected to last at least 12 months or until death, and these conditions must put the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.Moderate or high complexity medical decision making must be involved.
Clinical staff, under the direction of a physician or other qualified healthcare professional, provides complex chronic care management services.Responsibilities include communicating with the patient, caregivers, and other professionals; collecting data; assessing and supporting self-management; identifying and facilitating access to community and health resources; managing care transitions; reviewing patient status; and developing, communicating, and maintaining the care plan.
In simple words: Clinical staff, under the doctor's supervision, provides extra care for patients with two or more serious, long-term health problems. This service includes creating and managing a care plan, helping with medications, and coordinating with other healthcare providers. This code covers the first 60 minutes of this care each month.
Complex chronic care management services for patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. These chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.A comprehensive care plan is established, implemented, revised, or monitored, requiring moderate or high complexity medical decision making. This code covers the first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Example 1: A 70-year-old patient with congestive heart failure, diabetes, and chronic kidney disease requires medication management, coordination of specialist appointments, and assistance with diet and lifestyle modifications. Clinical staff provides these services under the physician’s direction, totaling over 60 minutes in a calendar month., A 45-year-old patient with multiple sclerosis, depression, and anxiety requires assistance with medication management, mobility exercises, and mental health support. Clinical staff spends over an hour this month coordinating care and providing resources, overseen by the physician., A child with asthma, severe allergies, and eczema needs close monitoring and coordination of care between allergists, pulmonologists, and dermatologists.The clinical staff devotes over 60 minutes this month managing these needs under the pediatrician’s guidance.
Detailed time logs of clinical staff activities, a comprehensive care plan, documentation of communication with patients, caregivers, and other healthcare professionals, and records of medical decision making complexity are required.
** Complex chronic care management services of less than 60 minutes duration in a calendar month are not reported separately.
- Specialties:Primary care, geriatrics, internal medicine, family medicine, pediatrics, and other specialties managing chronic conditions
- Place of Service:Office, Home, Assisted Living Facility, Skilled Nursing Facility, Nursing Facility, and other places where chronic care management is provided