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See a sample rate comparisonCPT 99489 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 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
| 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 | $78.16 national non-facility rate (2026) · View Medicare rates for 99489 |
| Medicaid Fee Schedule | $64.065 median of the 8 states in the free preview · View Medicaid rates for 99489 |
National average reimbursement for CPT 99489 by major payers:
$70.57
$56.55
$62.34
$101.36
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CPT 99489
5 of 25 sample ratesHigher to lower in this preview
Nina Gold
Mass General Brigham Incorporated
$131.77Published rateNicole Dilando
Children'S Health Care, Inc.
$71.62Published rateViveca Mishra
Harbor Health Medical Group
$46.99Published rateMaximiliano Hernandez
Maximiliano E. Hernandez, M.D., P.A.
$35.79Published rateRita Jermyn
Chs Physician Partners PC
$19.47Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| 99490-CPT | Low | Chrnc Care Mgmt Staff 1st 20, 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 First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
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.
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Frequently Asked Questions
To find the cost of a specific medical procedure, it's best to use a specialized tool. We recommend using Payerprice, which offers a fee schedule lookup tool. You can search for costs by entering the specific CPT code for the procedure and your geographic location to get transparent pricing information.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used to describe medical, surgical, and diagnostic services performed by healthcare providers. These codes standardize billing and allow for consistent pricing. To determine specific costs associated with a CPT code for your situation, you can use Payerprice's fee schedule lookup tool by inputting the CPT code and your location.
For reliable fee schedules for various medical services, you should utilize a dedicated lookup tool. Payerprice provides a comprehensive fee schedule lookup tool that allows you to search for pricing information based on specific CPT codes and your location, offering a clear view of service costs.
To look up the price of a medical service using Payerprice's fee schedule lookup tool, you will need the specific CPT code for the service you are interested in, along with your geographic location. These details are crucial for the tool to provide accurate and localized pricing estimates.
Payerprice helps you understand potential out-of-pocket costs by offering transparent pricing information for medical procedures. By using its fee schedule lookup tool with the procedure's CPT code and your location, you can obtain an estimate of standard charges. This information empowers you to have more informed discussions with your provider and insurer, helping you anticipate your financial responsibility.