Complex CCM 99487

Complex CCM 99487

Extended Code for Complex Medical Decision Making

More than one third of the patients currently enrolled in Chronic Care Management would benefit from or need a more thorough following.

CMS is reimbursing since 2017 for additional care under code 99487 and 99489 for Complex CCM.

  • Fuller care plans
  • Coordination with providers outside your practice
  • Additional time spent on and with your patients
  • Social services close to your CCM patients

Understanding the Requirements of Code 99487

This code is specific to Chronic Care Management and is the reimbursement of complex chronic care services for patients with:

patient with 2 or more chronic conditions Two or more chronic conditions

patient with 2 or more chronic conditions At least one condition being unstable

patient with 2 or more chronic conditions At least two risk factors from at least two separate domains

To be reimbursed for such care, practices must:


Contact each eligible patient every month.


Conduct at least 60 minutes of non face-to-face care.


Establish, implement, revise or monitor a comprehensive complex care plan.

Each additional 30 minutes of complex care is billed under the add-on CPT code 99489.

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Risk Factors and Domains:

Clinical Diagnoses, Behavioral Health, Special Needs

  • Chronic pain
  • Substance abuse
  • Behavioral health diagnosis
  • Terminal illness
  • Advanced age (75+) with frailty
  • Dementia/Alzheimer's Disease

Potential Physical Limitations

  • Non-ambulatory
  • Needs assistance with ADLs
  • Severely diminished functional status
  • Declining eyesight
  • At risk for falls
    • Fall in the last 6 months
    • Use of ambulatory aid
    • Use of sedative/hypnotic medications
    • Urinary incontinence

Social Determinants

  • Lack of financial support
  • Lack of family support that impacts care
  • Unemployed
  • Homelessness
  • Low health literacy
  • Unsafe home environment
  • Lack of transportation
  • Language barrier
  • Lives alone


  • Frequent hospitalizations
  • Frequent ER or urgent care visits
  • Multiple providers
  • Hospital Readmission in 30 days
  • Major procedure in the last year
  • Chronic kidney disease
  • Brain trauma
  • Expensive medications

Clinician/Patient Input

  • Polypharmacy: 4 or more prescription medications
  • High-risk medications that require tight titration or labs
  • Patient reports difficulty following treatment plan
  • Patient reports medication non-compliance
  • Visit to a long-term facility or other transition of care in last 90 days
  • Spouse recently deceased (in the past year)
  • Patient reports low confidence or ability to self-manage