How much does Medicare pay for CPT 99489?

Medicare allowed an average of $67.00 per service and paid $53.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $101.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99489 pay differently in an office than a hospital?

Yes. The allowed amount averaged $67.80 in an office setting and $46.96 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 99489 most?

Internal Medicine, with 414,654 services from 415 clinicians. Next are Nurse Practitioner, Family Practice, Emergency Medicine.

CPT 99489

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

$67.00Medicare-allowed amount per service, averaged across 1,389,391 services

Providers submitted

$101.20

Asking price, not received

Medicare allowed

$67.00

The fee schedule figure

Medicare paid

$53.26

Balance is patient coinsurance

Providers submitted an average of $101.20 for this code and Medicare allowed $67.00 — 1.5× 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 $53.26 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $67.80
Hospital / facility: $46.96

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. 1,335,938 services were billed in an office setting and 53,453 in a facility.

Services: 1,389,391
Beneficiaries: 143,098
Providers billing it: 2,003
Total allowed: $93,089,197

What Medicare pays for CPT 99489

Across 1,389,391 services billed by 2,003 providers to 143,098 beneficiaries, Medicare allowed an average of $67.00 per service. That is 9.7 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 99489

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	414,654	39,547	$69.73	415
Nurse Practitioner	332,173	35,567	$58.90	696
Family Practice	234,487	31,895	$69.19	396
Emergency Medicine	76,459	3,837	$67.49	14
Hospitalist	53,913	3,599	$68.58	11
Geriatric Medicine	43,711	2,886	$75.81	15
Anesthesiology	35,760	1,283	$70.68	18
General Practice	28,309	3,139	$65.75	27
Neurology	28,168	1,116	$64.40	8
Cardiology	22,057	3,470	$67.73	55
Physician Assistant	20,763	3,053	$58.89	65
Pain Management	17,626	1,287	$69.30	18
Osteopathic Manipulative Medicine	15,407	1,207	$78.77	4
Physical Medicine and Rehabilitation	13,485	2,678	$70.28	24
General Surgery	9,507	753	$78.53	2

99489 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
South Carolina	475,394	$62.84	$51.82	254
Texas	198,807	$67.65	$55.99	165
California	166,124	$75.53	$55.67	180
Florida	91,526	$65.31	$51.49	142
New York	71,845	$74.30	$54.82	94
New Jersey	71,554	$73.76	$55.76	64
Georgia	40,440	$64.08	$53.34	127
Illinois	38,784	$68.67	$53.11	70
North Carolina	38,135	$64.77	$53.73	69
Pennsylvania	24,855	$68.04	$54.31	89
Maryland	21,061	$71.03	$53.60	89
Michigan	20,963	$61.32	$49.88	103
Kentucky	20,125	$67.53	$56.36	16
Indiana	11,200	$66.37	$55.31	17
Minnesota	10,847	$58.79	$47.97	14
Nevada	9,036	$66.39	$53.04	56
Arizona	7,754	$61.21	$49.80	34
Wisconsin	6,580	$58.87	$48.64	9
Virginia	6,514	$67.88	$52.82	48
Colorado	6,424	$69.50	$55.80	26
Tennessee	6,134	$65.17	$54.44	41
Idaho	5,033	$57.13	$48.22	19
Kansas	4,772	$64.14	$55.00	17
Louisiana	4,181	$66.27	$55.83	14
Ohio	4,160	$65.95	$54.70	25
District of Columbia	3,762	$70.53	$54.15	8
Massachusetts	3,640	$67.38	$49.72	44
Delaware	2,439	$71.45	$56.48	20
New Hampshire	2,107	$65.67	$50.36	4
Utah	1,655	$58.13	$47.18	14
Connecticut	1,619	$66.42	$49.50	14
Arkansas	1,439	$64.47	$55.66	11
Missouri	1,377	$66.81	$55.03	7
Nebraska	1,258	$65.62	$54.59	7
Washington	1,076	$67.64	$49.44	10
Alabama	1,005	$61.82	$55.54	17
Mississippi	916	$65.93	$56.19	11
New Mexico	883	$57.53	$47.25	21
Oregon	804	$69.33	$56.05	4
North Dakota	627	$59.64	$47.97	4
Oklahoma	585	$63.79	$52.25	6
Hawaii	581	$64.16	$48.90	5
West Virginia	545	$48.99	$43.46	7
Wyoming	541	$70.17	$56.04	3
Iowa	190	$66.63	$56.57	3
Montana	94	$60.09	$47.84	1

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
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
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.