99487: First 60 minutes of clinical staff time directed by a physician or other qualified health care professional.
99489: Each additional 30 minutes after initial 60 minutes of clinical staff time per calendar month (an add-on code that should be reported in conjunction with 99487)
**This is written by CPT copyright guidelines definition. Please see each payer specific guidelines in the boxes below as there is some variation in time**
Description: Time spent coordinating care on behalf of patient without patient interaction (see examples in FAQs below). Please note, BCBSM does allow care team members to document their time spent when conversing with the patient via their patient portal.
Delivery Method: Can be conducted via telephone. 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:
May be used for portal communication and care coordination between the patient and the care team
Care coordinated by physician care manager
99487 is reported once per month for the first 60 minutes of clinical staff time for each additional 30 minutes report 99489
99489 should NOT be reported more than twice per calendar month
|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.
Q: What codes can be used when a PCP care team-member and a Specialist care team-member discuss a care plan?
A: Both care team members can bill the Care Coordination codes (99487,99489)
Q: Can a care team-member count their time for sending portal reminders for closing Gaps in Care (IE. Mammogram)?
A: No, sending out a reminder is a part of the day-to-day operations and shouldn't not be included.
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.