2025 CPT code 99489
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Care Management Services Feed
This code covers additional time spent by clinical staff, under the direction of a physician or other qualified healthcare professional, for complex chronic care management services beyond the first hour.
Applicable modifiers may include modifier 25 (Significant, Separately Identifiable E/M Service) when performed on the same day as another service.
Medical necessity for complex chronic care management services must be clearly documented. The patient must have multiple chronic conditions that pose significant risks to their health and require ongoing management and coordination of care.The complexity of the medical decision making must also be supported.
Clinical staff, under the direction of a physician or other qualified healthcare professional, provides these services. Staff responsibilities may include communication with patients, caregivers, and other professionals; data collection; medication management support; and care plan maintenance. The physician or other qualified healthcare professional oversees and directs the clinical staff’s activities.
In simple words: If a patient has two or more serious, long-term health conditions, medical staff spend extra time coordinating their care. This code bills for each 30 minutes of that extra time spent by staff, after the first hour of care.
Complex chronic care management services involve clinical staff time directed by a physician or other qualified healthcare professional, per calendar month. This code is used for each additional 30 minutes beyond the initial 60 minutes billed under 99487 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 must put the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. A comprehensive care plan must be established, implemented, revised, or monitored. The care involves moderate or high complexity medical decision making.
Example 1: A patient with congestive heart failure and diabetes requires ongoing care coordination.After an initial 60 minutes of care coordination (99487), the clinical staff spends an additional 45 minutes communicating with specialists, adjusting medications, and updating the care plan.99489 is reported once to account for the additional 30 minutes beyond the first hour., A patient with chronic obstructive pulmonary disease (COPD) and dementia requires care coordination across multiple specialists, including a pulmonologist, neurologist, and physical therapist.Clinical staff spend 2 hours and 15 minutes this month coordinating care. 99487 is reported for the first hour, and 99489 is reported three times for each additional 30-minute block. , A child with multiple chronic conditions needs 1 hour and 45 minutes of care coordination in a month involving communication with multiple therapists and specialists, as well as medication and treatment adjustments. 99487 is reported for the first hour, and 99489 is reported once for the additional 30 minutes.
Detailed documentation should support the medical necessity of the complex chronic care management services.This should include the patient's chronic conditions, the complexity of the care, the time spent by clinical staff, and the services provided. The documentation must support the moderate or high level of medical decision-making involved.
- Specialties:Many specialties may use this code, including primary care, internal medicine, geriatrics, pediatrics, and other specialties managing patients with multiple chronic conditions.
- Place of Service:This code can be billed in various places of service, including "Office" and "Home."