How much does Medicare pay for CPT 99487?

Medicare allowed an average of $124.70 per service and paid $97.31 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $202.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99487 pay differently in an office than a hospital?

Yes. The allowed amount averaged $126.63 in an office setting and $82.99 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99487 most?

Internal Medicine, with 188,286 services from 688 clinicians. Next are Family Practice, Nurse Practitioner, Cardiology.

CPT 99487

Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month

$124.70Medicare-allowed amount per service, averaged across 599,999 services

Providers submitted

$202.74

Asking price, not received

Medicare allowed

$124.70

The fee schedule figure

Medicare paid

$97.31

Balance is patient coinsurance

Providers submitted an average of $202.74 for this code and Medicare allowed $124.70 — 1.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $97.31 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $126.63
Hospital / facility: $82.99

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 573,530 services were billed in an office setting and 26,469 in a facility.

Services: 599,999
Beneficiaries: 212,632
Providers billing it: 2,946
Total allowed: $74,819,875

What Medicare pays for CPT 99487

Across 599,999 services billed by 2,946 providers to 212,632 beneficiaries, Medicare allowed an average of $124.70 per service. That is 2.8 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99487

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	188,286	61,749	$127.51	688
Family Practice	128,422	48,841	$128.80	619
Nurse Practitioner	126,464	48,514	$111.01	931
Cardiology	22,434	7,317	$132.84	85
Emergency Medicine	17,022	4,527	$127.74	20
Geriatric Medicine	13,818	3,536	$141.67	25
General Practice	11,767	4,287	$125.41	39
Physician Assistant	11,613	4,904	$110.89	96
Hospitalist	11,015	4,054	$130.54	17
Nephrology	6,803	1,902	$107.21	54
Anesthesiology	6,758	1,549	$131.21	20
Neurology	6,658	1,426	$121.41	14
Interventional Cardiology	6,287	2,044	$130.12	22
Physical Medicine and Rehabilitation	6,021	2,951	$127.58	26
Urology	5,235	2,495	$134.63	122

99487 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	105,316	$125.23	$101.11	296
South Carolina	87,725	$116.02	$94.64	275
California	76,327	$135.57	$98.16	274
Florida	53,591	$121.02	$95.74	252
New York	37,921	$140.08	$97.94	217
Georgia	30,045	$122.41	$99.41	152
New Jersey	29,481	$130.52	$95.92	92
Illinois	19,777	$127.21	$97.47	94
Michigan	16,968	$118.81	$93.50	134
North Carolina	13,032	$119.90	$98.39	93
Maryland	11,063	$129.82	$95.61	100
Pennsylvania	9,051	$124.71	$98.00	99
Indiana	8,354	$122.05	$101.43	27
Nevada	7,958	$123.51	$97.38	66
Alabama	6,655	$102.92	$102.57	52
Louisiana	6,574	$122.13	$100.73	26
Virginia	6,442	$130.78	$100.68	62
Oklahoma	5,932	$116.05	$101.46	14
Arizona	5,777	$116.05	$94.50	55
Tennessee	5,518	$119.49	$99.72	51
Kentucky	4,994	$124.43	$102.85	22
Kansas	4,784	$121.15	$101.36	21
Wisconsin	4,227	$112.26	$90.15	15
Massachusetts	4,012	$122.93	$90.79	75
Ohio	3,860	$120.06	$96.96	41
Minnesota	3,853	$110.85	$89.58	26
Colorado	2,998	$132.42	$99.57	28
Idaho	2,916	$105.40	$88.49	23
Connecticut	2,685	$126.57	$91.84	28
Arkansas	2,508	$113.33	$94.32	32
District of Columbia	2,327	$138.63	$101.17	9
Delaware	2,093	$132.33	$103.63	21
Oregon	2,059	$118.96	$90.12	14
Mississippi	1,949	$118.25	$102.05	27
Washington	1,940	$128.60	$94.49	15
Nebraska	1,896	$115.94	$95.78	16
Utah	1,868	$104.89	$89.83	20
New Hampshire	940	$121.29	$92.09	4
Missouri	782	$122.11	$99.58	10
West Virginia	646	$80.86	$75.53	14
Hawaii	591	$120.17	$88.49	5
New Mexico	577	$106.79	$86.72	24
Wyoming	480	$121.47	$95.55	5
Rhode Island	428	$134.71	$103.86	2
Iowa	421	$122.41	$103.44	10
North Dakota	355	$110.90	$86.91	4
Alaska	195	$164.43	$104.51	1
Montana	108	$111.80	$87.14	3

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08
99484Care management services for behavioral health conditions$50.05

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.