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CPT 99489
Description, Billing Rules, and Use Cases

CPT 99489 is an add-on billing code used to report additional 30 minute blocks of Complex Chronic Care Management (CCCM) services provided by clinical staff under the supervision of a physician or other qualified healthcare professional.

 

This code must be billed alongside CPT 99487 and reflects time spent beyond the initial 60-minute threshold in a calendar month.

 

If your care team provides 90 minutes or more of qualifying care in a calendar month, CPT 99489 can and should be billed alongside 99487.

What is CPT Code 99489?

CPT code 99489 is used to report additional time, in increments of 30-minutes, for Complex Chronic Care Management (CCCM) services delivered by clinical staff under physician supervision. This code may only be billed in conjunction with CPT 99487, which covers the first 60 minutes of qualifying time per calendar month.

 

CPT 99489 should be used in cases where:

 

  • The patient has two or more chronic conditions expected to last at least 12 months or until death

  • The conditions place the patient at significant risk of death, acute decompensation, or functional decline

  • A comprehensive care plan is in place, maintained, and updated as necessary

  • Medical decision-making is of moderate or high complexity

  • The total clinical staff time reaches at least 90 minutes in a calendar month

  • Multiple units of 99489 may be billed when additional 30-minute increments are met beyond the initial hour. Time must be distinctly documented and may not overlap with other CCM, PCM, or transitional care codes.
     

CPT 99489 Billing Requirements and Eligibility

CPT 99489 is an add-on billing code and can only be used in conjunction with CPT 99487. The following requirements must be met for reimbursement and compliance.

Patient Eligibility Criteria

  • The patient must have two or more chronic conditions which:

    • Are expected to last at least 12 months, or until the patient’s death

    • Place the patient at significant risk of functional decline, acute exacerbation, or hospitalization
       

  • A comprehensive care plan must be:

    • Established, implemented, revised, or monitored

    • Documented in the medical record

    • Shared with the patient and/or caregiver when appropriate

Provider Requirements

  • CPT 99489 must be billed by a physician, nurse practitioner, or physician assistant

  • Services must be delivered by clinical staff under the provider’s direction

  • The billing provider must also report CPT 99487 in the same calendar month

Service Requirements

  • A minimum of 90 minutes of qualifying clinical staff time must be documented

  • CPT 99489 accounts for each additional 30-minute increment beyond the first 60 minutes

  • Multiple units (e.g., 99489 ×2, ×3) may be reported when applicable

  • Time must be separate and distinct from services reported under other codes

CPT 99489 Billing Documentation Checklist

To ensure clean claims and audit-ready documentation, your care team must keep accurate records that support all billing activity under CPT 99489.

 

Make sure your documentation includes:

  • At least 90 minutes of total clinical staff time in the calendar month
    (Document exact dates, times, and tasks in the EHR or tracking system)

  • Clear identification of CPT 99487 + CPT 99489 as the paired codes for the claim

  • A comprehensive care plan that was:

    • Established, implemented, revised, or monitored during the billing period

    • Tailored to all chronic conditions

    • Stored in the patient record and shared as appropriate

  • Evidence of moderate or high complexity medical decision-making
    (e.g., multiple medications, coordination across providers, high-risk comorbidities)

  • Confirmation that time does not overlap with any of the following:

  • Use of clinical staff time only
    (Exclude time spent by physicians or NPs unless personally delivering care billed under other codes)

CPT 99489 Time Thresholds and Code Combinations

CPT 99489 is used to report each additional 30 minutes of Complex Chronic Care Management (CCCM) services beyond the first 60 minutes covered by CPT 99487. It may be billed multiple times per calendar month if the required time thresholds are met and properly documented.

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Use the following chart to determine the correct billing combination based on total qualifying time:

Billing table for CPT 99489 showing required combinations of CPT 99487 and 99489 based on total clinical staff time in 30-minute increments. CPT 99487 is billed for 60–89 minutes; 99489 is added for each additional 30 minutes starting at 90 minutes. Table includes examples through 240+ minutes.

Key Reminders:

  • CPT 99489 may only be billed in conjunction with CPT 99487

  • Time must be non-overlapping, clearly documented, and provided by clinical staff

  • Time used for 99489 must not be counted toward any other care management or E/M service

When to Use CPT 99489:
Common Scenarios and Use Cases

CPT 99489 should be billed whenever your care team provides 90 minutes or more of qualifying Complex Chronic Care Management services in a calendar month. These services must be delivered by clinical staff under a provider’s supervision and meet the documentation and time requirements outlined above.

 

Here are some real-world examples of when to use 99489 correctly:

​

  • High-Risk CHF + Diabetes
    A patient with congestive heart failure and diabetes requires:

    • Weekly medication review

    • Coordination with home health

    • Dietary and lifestyle coaching

    • Regular check-ins with multiple specialists
      Total qualifying time: 100 minutes
      Billing: 99487 (first 60 min) + 99489 (additional 30 min)

​

  • Nurse-Led Complex Care Coordination
    A care team spends significant time managing a patient’s

    • Polypharmacy risks

    • Social service needs

    • Post-hospitalization transitions

    • Coordination across behavioral and primary care
      Total qualifying time: 150 minutes
      Billing: 99487 + 99489 ×2

​

  • Assisted Living Support Plan
    A care team working with a caregiver and facility staff supports a patient with:

    • Cognitive impairment

    • Limited mobility

    • Daily monitoring needs

    • Regular care plan revisions
      Total qualifying time: 180 minutes
      Billing: 99487 + 99489 ×4

Common CPT 99489 Billing Mistakes
(and How to Avoid Them)

  • ❌ Billing 99489 Without 99487
    CPT 99489 is an add-on code only. It may never be billed on its own and must always appear alongside CPT 99487 on the claim.
     

  • ❌ Reporting for Fewer Than 90 Minutes of Total Time
    You must document at least 90 minutes of qualifying clinical staff time before billing CPT 99489. Anything less than that should be billed under 99487 alone — or not at all if under 60 minutes.
     

  • ❌ Overlapping Time With Other CCM or PCM Codes
    You cannot bill CPT 99489 if the same time period is also used for:

    • CPT 99490 or 99491 (standard CCM)

    • Principal Care Management codes (99424–99427)

    • Behavioral Health Integration (99484, 99492–99494)

    • Transitional care codes (99495–99496)

    • Only non-overlapping time may be counted toward 99489 billing thresholds.​
       

  • ❌ Inadequate Documentation of Clinical Staff Time.
    Clinical staff time must be:

    • Tracked in 30-minute increments

    • Logged with specific dates, times, and activities

    • Distinct from any other services billed under separate codes

    • Missing time logs or vague care notes are frequent triggers for payer rejections.
       

  • ❌ Counting Provider Time Instead of Staff Time
    CPT 99489 is based solely on clinical staff time. Time spent by physicians, NPs, or PAs does not count unless they are delivering direct services under other billable codes.

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