CPT 99487 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Care Management Services |
| Common Place of Service | • 11 - Office • None • 99 - Other POS |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Low |
National average reimbursement for CPT 99487 by major payers:
$134.84
$110.81
$121.88
$190.20
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99487 | ||||||
United | 99487 | $111.41 | 1841243110 - NELSON BERRIOS | 741824287 - (TX) MEMORIAL NEUROLOGICAL ASSOCIATION | TX | Neurology Physician (2084N0400X) |
United | 99487 | $197.66 | 1215380753 - ANDREA STARK | 550526150 - CHARLESTON AREA MEDICAL CENTER INC | TX | Internal Medicine Physician (207R00000X) |
United | 99487 | $272.54 | 1952384174 - WANDA GONZALEZ | 1952384174 - (MA) WANDA GONZALEZ | MA | Pediatrics Physician (208000000X) |
United | 99487 | $215.14 | 1083009971 - CARA WEINSTEIN | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99487 | $201.08 | 1538139233 - COLIN SOX | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99487 | $78.52 | 1962484378 - MICHAEL ANNABI | 562466775 | TX | Internal Medicine Physician (207R00000X) |
United | 99487 | $300.05 | 1073550679 - LLOYD FISHER | 42472266 - (MA) RELIANT MEDICAL GROUP, INC. | MA | Pediatrics Physician (208000000X) |
United | 99487 | $121.94 | 1659509990 - SRIDHAR VENKATACHALAM | 752616977 - CHRISTUS TRINITY CLINIC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99487 | $144.13 | 1023508082 - MOSTAFA SALEM | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99487 | $149.75 | 1093731812 - MELINDA HARRELL | 752736045 - (TX) ELIS MEDICAL CORPORATION | TX | Internal Medicine Physician (207R00000X) |
United | 99487 | $201.08 | 1831659689 - ANTHONY MELL | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99487 | $92.01 | 1356688436 - INPATIENT PROVIDERS OF TEXAS, PLLC | 453934173 - (TX) INPATIENT PROVIDERS OF TEXAS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99487 | $83.50 | 1932192796 - ANNE JOSEPHS | 454077626 - (CT) DAY KIMBALL MEDICAL GROUP INC | MA | Pediatrics Physician (208000000X) |
United | 99487 | $272.54 | 1285838854 - SUSANNAH KISVARDAY | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99487 | $201.08 | 1073581906 - PATRICK CONWAY | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99487 vs. Other Care Management Services Codes
The CPT 99487 code is part of the Evaluation and Management services used for Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99487 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99483-CPT | Moderate | Assessment Of And Care Planning For A Patient Withcognitive Impairment Requiring An Independent Historian In The Office Or Other Outpatient Home Or Domiciliary Or Rest Home With All Of The Following Required Elements:Cognition-Focused Evaluation Including A Pertinent History And Examination Medical Decision Making Of Moderate Or High Complexity;Functional Assessment Including Decision-Making Capacity Use Of Standardized Instruments For Staging Typically 60 Mins Of Total (Desc Rvsd 1/1/23) |
| 99484-CPT | Low | Care Management Services For Behavioral Health Conditions At Least 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month Withthe Following Required Elements: Initial Assessment Or Follow-Up Monitoring Including The Use Of Applicable Validated Rating Scales; Behavioral Health Care Planning In Relation To Behavioral/Psychiatric Health Problems Including Revision For Patients Who Are (Desc Rvsd 1/1/22) |
| 99487-CPT | Low | 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, 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. |
| 99489-CPT | Low | 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, Comprehensive Care Plan Established, Implemented, Revised, Or Monitored, Moderate Or High Complexity Medical Decision Making; Each Additional 30 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional, Per Calendar Month (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99487. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99487 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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