99487: First 31-75 minutes of clinical staff time per calendar month
99489: Each additional 30 minutes after initial 75 minutes of clinical staff time per calendar month (an add-on code that should be reported in conjunction with 99487)
Description: Time spent coordinating care on behalf of patient without patient interaction (see examples in FAQs below)
Delivery Method: Prior authorization, chart prep, email, and non-verbal communication cannot be included, but researching resources on behalf of the patient is considered a valid care coordination effort
Who Can Bill? Any licensed or unlicensed care-team member, including medical assistants or community health workers, who has completed Introduction to Team-Based Care within 6 months of billing (for unlicensed care-team members, a scope of service document is also required)
For visits >75 minutes, bill quantities:
|Priority Health||Care coordinated by physician care manager||Cumulative services provided must be by either a physician or QHP (licensed staff)|
|Medicaid (varies by HMO)||Not billable by a physician|
Billing opportunities and reimbursement may vary depending upon organization's specific payer value-based contracts. All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.
MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors.
- Date and duration of interaction regarding patient
- Care team member name and credentials
- Identification of provider or community agency
- Nature of discussion and pertinent details focusing on coordinating services pertinent to patient’s individual care plan and goal achievement such as coordinating services to manage the patient’s medical condition, psychosocial needs, and activities of daily living.
Care Coordination Code FAQs
For additional PDCM FAQs, please click here
Q: Historically, many forms were completed as phone outreach however many organizations have converted to online. Would time spent completing online forms such as CPS intake, court and/or school documents be considered as care coordination?
A: Yes, as the care-team member would be spending the same amount of time on the telephone as he/she would be online.
Q: How can I get reimbursed for time spent coordinating services with other providers/services (i.e., home health, specialty offices, community resources, etc.)?
A: When providing non-face-to-face clinical coordination with the patient-centered medical neighborhood, a care team member must accumulate at least 31 minutes of time spent within a calendar month and submit code: 99487 or 99489. Individual organizations will need to develop internal workflows for capturing and tracking each contact until the total time is collected.
Below are some additional examples of what is included in time spent coordinating care on behalf of the patient without the direct interaction of the patient.
- Finding drug financial programs
- Applying for patient assistance programs
- Confirming treatments indicated for diagnosis
- Coordinating the first prescription fill within specialty pharmacy.
Below are some examples of what is not included in time spent coordinating care on behalf of the patient without the direct interaction of the patient.
- Checking benefit coverage
- Prior Authorization
- Completing documentation
Care Coordination Codes Scenario
Within the same month, care-team member contacts the home health agency to schedule in-home visits and conduct a safety assessment. (11 Minutes)
Care team member contacts DME provider to arrange for delivery of home O2. (10 Minutes)
Care team member contacts DHHS to assist with community resources for legal aid. (10 minutes)
Total of 31 minutes within the same month.