CMS RVU26D · Effective 2026-10-01
Report monthly complex chronic care management after 60 minutes of directed clinical staff time for high-risk patients requiring complex decisions and comprehensive care planning. Compare 99487 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
$153.35
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
$79.30
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Care management
Report monthly complex chronic care management after 60 minutes of directed clinical staff time for high-risk patients requiring complex decisions and comprehensive care planning.
This service covers non-face-to-face care coordination during a calendar month for patients with at least two chronic conditions expected to last 12 months or until death. The conditions must place the patient at significant risk of death, acute exacerbation or decompensation, or functional decline. Clinical staff work under the direction of a physician or other qualified health care professional to establish or substantially revise a comprehensive care plan. Activities can include medication management, communication with specialists, and coordination with home health services and caregivers. Primary care and geriatrics practices commonly provide this service for patients with multiple serious conditions.
Report one unit of 99487 per calendar month after at least 60 minutes of qualifying clinical staff time and moderate- or high-complexity medical decision making. Document patient consent, the conditions and associated risks, the established or substantially revised care plan, decision making, and dated time entries describing the work performed. Only one practitioner may bill chronic care management for the patient that month. Medicare requires an initiating face-to-face visit for a new patient or one not seen within the preceding year. Report 99489 for qualifying additional staff time beyond the first 60 minutes.
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This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Office rates for Guam, from the same CMS release.
99490 begins at 20 minutes of clinical staff time and does not require complex decision making or substantial care plan revision. 99487 requires 60 minutes, moderate- or high-complexity decision making, and plan establishment or substantial revision.
99491 is based on at least 30 minutes of care management personally performed by the physician or qualified health care professional. 99487 begins at 60 minutes of qualifying time and requires complex decision making and care plan work.
99489 is an add-on for qualifying clinical staff time beyond 99487's first 60 minutes; its first unit begins at 16 additional minutes. Report 99487 once per qualifying calendar month.
99496 covers transitional care after discharge, including high-complexity decision making and a face-to-face visit within seven days. 99487 covers complex chronic care management during a calendar month.
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Office / nonfacility
$153.35
Facility
$79.30
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Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99487 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
13,152
GPCI2026.csv
46
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.81 | × 1.000 | 1.8100 |
| Practice expense | 2.38 | × 1.137 | 2.7061 |
| Malpractice | 0.13 | × 0.579 | 0.0753 |
| Total RVUs | 4.5913 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$153.35
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.81 | 1 |
| Practice expense | 2.38 | 1.137 |
| Malpractice | 0.13 | 0.579 |
(1.81 × 1 + 2.38 × 1.137 + 0.13 × 0.579) × $33.4009 = $153.35
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.81 | 1 |
| Practice expense | 0.43 | 1.137 |
| Malpractice | 0.13 | 0.579 |
(1.81 × 1 + 0.43 × 1.137 + 0.13 × 0.579) × $33.4009 = $79.30
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
Use 99487 when the month includes at least 60 minutes of qualifying time, moderate- or high-complexity medical decision making, and establishment or substantial revision of the care plan. Code 99490 requires at least 20 minutes of clinical staff time but does not require those complex-care elements.
No. Select the chronic care management code family that matches the month's work rather than reporting complex and non-complex chronic care management together.
Report one unit of add-on code 99489 when additional qualifying clinical staff time reaches 16 minutes beyond the first 60. Apply the midpoint rule to subsequent 30-minute increments.
Do not report 99487. If the month's care meets 99490 requirements, report 99490 once at least 20 minutes of qualifying clinical staff time has accumulated.
The billing practitioner may count time personally spent performing qualifying care management activities. Time used for another separately reported service cannot be counted again.
Document patient consent, qualifying chronic conditions, the established or substantially revised comprehensive care plan, moderate- or high-complexity decision making, and dated entries supporting at least 60 minutes of qualifying work.
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
