Billing code 99487: Complex chronic care managementMedicare rate & RVUs in Ohio
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.
Medicare pays $137.41 for 99487 in the office in Ohio (Ohio). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 99487 covers
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.
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.
99487 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $137.41 | $77.95 |
How the 99487 rate is calculated
Each of 99487’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99487
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.81Practice expense 2.38Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99487
99487 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99487
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$144.29
The facility rate would be $79.16 (+$65.13). In a facility, the facility bills its own costs separately.
99487 compared with similar codes
Compare codes
99487 vs 99490 vs 99491 vs 99489 vs 99496: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99490Chronic care management
- 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.
- 99491Chronic care management
- 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.
- 99489Complex chronic care management
- 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.
- 99496Transitional care management
- 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.
99487 billing questions
When should 99487 be reported instead of 99490?
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.
Can 99487 and 99490 or 99491 be billed for the same patient in the same month?
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.
How is time beyond 60 minutes reported?
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.
What happens if staff time falls short of 60 minutes?
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.
Does the billing practitioner's own time count toward the 60 minutes?
The billing practitioner may count time personally spent performing qualifying care management activities. Time used for another separately reported service cannot be counted again.
What documentation supports 99487?
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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 99487 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →