Cplx chrnc care 1st 60 min
Complex chronic care management for ongoing health conditions costs between $79.55-$160.67 depending on your facility type, so review your billing statements immediately to verify proper charges.
About the analyst
Michael Glenn reviews CMS datasets and drug pricing at BillRazor Research. He focuses on NADAC acquisition costs and procedure coding accuracy. Expertise: drug pricing, NADAC data, CPT coding.
Complex chronic care management involves extended coordination of care services for patients with multiple serious long-term conditions, requiring at least 60 minutes of clinical staff time per month. This service typically applies to patients managing conditions like diabetes, heart disease, and COPD who need ongoing medication management and care coordination between multiple providers. Medicare reimburses this code at approximately $180, though facility charges can vary significantly across different healthcare settings.
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Facility rate
$80
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
3
23 data points
Key insights for CPT 99487
Facility vs office setting
$19 differenceFacility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $80 | Lowest |
| Non-facility (office) | $99 | +24% |
| Outpatient (APC) | $161 | +102% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
Related pricing data
Data: Federal physician fee schedules, hospital payment data, surgery center rates, lab fee schedules, and drug pricing data. FY 2024. All publicly available from federal sources.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use