CPT 99487: Complex CCM, first 60 min
Complex CCM covers a higher-intensity month: at least 60 minutes of clinical staff time, moderate or high complexity medical decision-making, and a care plan that is established or substantially revised.
CPT 99487 at a glance
- Time threshold
- 60 minutes of clinical staff time per calendar month
- Who performs it
- Clinical staff under the billing practitioner's direction
- How often
- Once per patient per calendar month, by one practitioner
- Approx. 2026 national rate
- ~$132
Used instead of 99490 for the same patient and month, not alongside it.
What the record needs to show
- Two or more chronic conditions expected to last at least 12 months or until death, with significant risk of decline
- Moderate or high complexity medical decision-making documented by the practitioner
- Establishment or substantial revision of the comprehensive care plan that month
- Documented consent and a time log reaching 60 minutes
Common billing mistakes
- Using 99487 when the care plan was not actually revised that month
- No documented decision-making level to support the code
- Billing 99487 and 99490 together for the same patient and month
Where Zenith fits
Your practice stays the billing provider for CPT 99487. Zenith supplies trained clinical staff who do the work inside your EHR and invoice your practice for the labor. Zenith does not bill Medicare. See Chronic Care Management for how the program runs.
Educational summary, not billing or legal advice. Rates are 2026 Medicare national averages and vary by locality and payer. Confirm current rules in the CMS Physician Fee Schedule and with your Medicare Administrative Contractor.