CPT 99489 Fee Schedule
Last Updated: April 2025
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)
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 Place of Service |
| Common Modifiers | • None • 25 - Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service • 95 - Synchronous telemedicine service via real-time audio and video telecommunications |
| Complexity Level | Moderate |
National average reimbursement for CPT 99489 by major payers:
$70.57
$56.14
$62.34
$104.24
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99489. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99489 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.
CPT 99489 vs. Other Care Management Services Codes
The CPT 99489 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 99489 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 99484 | 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 | 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 | 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) |
| 99490 | Low | Chronic Care Management Services With The Following Required Elements: Multiple (Two Or More)Chronicconditions Expected To Last At Least 12 Months Oruntil The Death Of The Patient Chronic Conditionsplace The Patient At Significant Risk Of Death Acute Exacerbation/Decompensation Or Functional Decline Comp Care Plan Established Implemented Revised Or Monitored; First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qhp Per Calendar Month. (Desc Rvsd 1/1/22) |
See what providers are getting paid in 2024 for 99489:
CPT 99489 Fee Schedule & Reimbursement Rates
The CPT 99489 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99484 | $54.92 | $87.87 | |
| 99487 | $134.15 | $190.20 | |
| 99489 | $72.23 | $104.24 | |
| 99490 | $62.58 | $91.60 | |
| 99491 | $84.55 | $139.82 | |
| 99499 | $188.67 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
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