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See a sample rate comparisonCPT 99487 Fee Schedule
Last Verified: October 2026
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.
Cplx Chrnc Care 1st 60 Min, 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Management Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $144.29 national non-facility rate (2026) · View Medicare rates for 99487 |
| Medicaid Fee Schedule | $118.265 median of the 8 states in the free preview · View Medicaid rates for 99487 |
National average reimbursement for CPT 99487 by major payers:
$134.84
$110.81
$121.88
$186.37
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CPT 99487
5 of 25 sample ratesHigher to lower in this preview
Lloyd Fisher
Reliant Medical Group, Inc.
$300.05Published rateSamuel Loren
University Of Vermont Medical Center Inc
$231.41Published rateMelinda Harrell
Elis Medical Corporation
$149.75Published rateArthur Davis
South Louisiana Medical Associates
$108.87Published rateNancy Burt
Alamo Neurology Consultants PA
$71.08Published rate
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See a sample payer proposalCPT 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 | Assmt Care Pln Pt Cog Imp, Assessment Of And Care Planning For A Patient With Cognitive 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 Eg Basic And Instrumental Activities Of Daily Living Including Decision Making Capacity Use Of Standardized Instruments For Staging Of Dementia Eg Functional Assessment Staging Test Fast Clinical Dementia Rating Cdr Medication Reconciliation And Review For High Risk Medications Evaluation For Neuropsychiatric And Behavioral Symptoms Including Depression Including Use Of Standardized Screening Instrument S Evaluation Of Safety Eg Home Including Motor Vehicle Operation Identification Of Caregiver S Caregiver Knowledge Caregiver Needs Social Supports And The Willingness Of Caregiver To Take On Caregiving Tasks Development Updating Or Revision Or Review Of An Advance Care Plan Creation Of A Written Care Plan Including Initial Plans To Address Any Neuropsychiatric Symptoms Neuro Cognitive Symptoms Functional Limitations And Referral To Community Resources As Needed Eg Rehabilitation Services Adult Day Programs Support Groups Shared With The Patient And Or Caregiver With Initial Education And Support Typically 60 Minutes Of Total Time Is Spent On The Date Of The Encounter |
| 99484-CPT | Low | Care Mgmt Svc Bhvl Hlth Cond, 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 With The 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 Not Progressing Or Whose Status Changes Facilitating And Coordinating Treatment Such As Psychotherapy Pharmacotherapy Counseling And Or Psychiatric Consultation And Continuity Of Care With A Designated Member Of The Care Team |
| 99487-CPT | Low | Cplx Chrnc Care 1st 60 Min, 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 |
| 99489-CPT | Low | Cplx Chrnc Care Ea Addl 30, 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 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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Frequently Asked Questions
CPT 99487 reports the first 60 minutes per calendar month of complex chronic care management by clinical staff directed by a physician or other qualified health care professional, for a patient with two or more serious chronic conditions.
It requires a comprehensive care plan that is established or substantially revised, and moderate or high complexity medical decision making. Each additional 30 minutes is reported with 99489.
Medicare pays CPT 99487 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 99487 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.