Forum - Questions & Answers

Apr 25th, 2022 - nia 4 

Ccm billing

Based on the 2022 WPS MPF schedule; complex CCM is billed monthly, although the tasks are required daily for our patients. Referral, documentation, and orders for DME equipment can take 4 hrs. After billing 1 unit for 60 minutes, with the code 99487- the additional 180min equals 6 units/additional 30min. The fee is listed on the schedule; should we multiply that fee x 6, for each unit?

Apr 26th, 2022 - ChrisW   256  1 


That is correct CCM requires at least 60 minutes of clinical staff time, under the direction of a physician or other qualified health care professional.  99847 is reported only one time during the first 30 days.
Any additional time is reported using the add-on code 99489 for each additional 30 minutes. See the example below. Each time a code is reported it is considered one unit, therefore, if charging an additional 3 units, you will charge for the initial 60 minutes 1 time and the other three units as the additional charge (a total of 4 units according to the fee schedule). 
90-119 minutes (1 hr 30 min - 1 hr 59 min)  99487 X 1 and 99489 x1
120 minutes or more (2 hours or more) 99487 X 1 and 99489 x2 and 99489 for each additional 30 minutes

Apr 26th, 2022 - nia 4 

Ccm billing

Thank you. I am still not clear on the 99487 being billed once every 30 days, but 99489 is an add-on code for additional time spent throughout the month. Even if the billing is held until the end of the month, the units would exceed the MUE limit in a single claim.If a patient required CCM follow-up three times in one month on different days, and we can only claim 99487 once/month, would we use an E/M procedure code as the primary code such as 99606, or 98966-68 and also 99489 as an add-on code with corresponding units on other days in the month?

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