99487 Insurance Policy Changes

CPT 99487, in plain terms, covers Bill once per calendar month when clinical staff, directed by a physician or other qualified provider, put in the first 60 minutes coordinating care for a patient with multiple chronic conditions and the provider's decision making is moderate or high complexity. CPT 99487 is referenced in 6 tracked payer policy changes from Blue Cross of Idaho, Maryland Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99487 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 99487 on AAPC

Blue Cross of Idaho · Identified Sep 29, 2026High impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCS) - Added FQHC Billing Guidelines document
Blue Cross of Idaho provider administrative policy MAP111 sets billing requirements for federally qualified health centers (FQHCs) submitting claims for qualifying visits under the CMS Prospective Payment System, for Medicare Advantage members. Qualifying FQHC claims must use type of bill 77X and include revenue code(s) 0519, 0521, 0522, 0524, 0525, 0527, 0528, and/or 0900, and listed qualifying services for Medicare Advantage patients must include the corresponding CMS PPS payment code (HCPC).
Maryland Medicaid · Effective May 15, 2025Medium impact
Update to Reimbursement for Remote Patient Monitoring Services: Self-Measured Blood Pressure Codes
Maryland Medicaid has updated Remote Patient Monitoring (RPM) and Self-Measured Blood Pressure (SMBP) coverage, eliminating prior authorization requirements for RPM and adding new billable SMBP codes 99473 and 99474. Code S9110 is no longer covered for RPM services.
Blue Cross of Idaho · Identified Oct 6, 2026Medium impact
MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Added language about preventive exams and revised billing instructions for care coordination, VCS, CoCM, telehealth, and vaccines per CMS coding updates.
Blue Cross of Idaho revised its Medicare Advantage billing policy for Rural Health Clinics in September 2026 to add preventive exam language and update how care coordination, virtual communication services, psychiatric collaborative care, telehealth and vaccines are billed, following CMS coding changes. The policy gives no single effective date for the September 2026 revision, but it lists code-specific dates of January 1, 2026 and October 1, 2026, both now passed. The entry for G0511 reads 'Oct. 1, 25', which is unclear, so confirm that date with Blue Cross of Idaho.
Blue Cross of Idaho · Identified Oct 6, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams
Blue Cross of Idaho's FQHC billing policy for Medicare Advantage claims, with the September 2026 revision that added language on preventive exams. Preventive exams (CPT 99381 through 99387) are billed separately on a CMS-1500 claim, and FQHC qualifying visits need the right type of bill, revenue code and CMS payment HCPCS code, because claims missing any of these are denied and returned for correction. The policy text states no effective date of its own, so confirm the current rules on the payer's site.
Blue Cross of Idaho · Identified Sep 29, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification
Blue Cross of Idaho's billing policy for federally qualified health centers (FQHCs) on Medicare Advantage claims, last revised September 2026 to add preventive exam language. FQHC qualifying visits must carry the right type of bill, revenue code and CMS payment HCPCS code, and claims missing any of these are denied and returned for correction, so the FQHC billing team needs to confirm its claim setup against the current list.
Oregon Health Plan · Identified Jun 20, 2026Medium impact
Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service primary care rates.
Oregon Health Authority is increasing Medicaid fee-for-service primary care rates by 2%, raising the conversion factor from $27.82 to $28.50. This affects evaluation and management codes, immunization administration codes, and health/behavior assessment codes.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 99487?

CalViva Health lists 99487 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 99487?

Community Health Plan of Imperial Valley lists 99487 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 99487?

There are 6 tracked policy changes affecting CPT 99487, including updates from Blue Cross of Idaho, Maryland Medicaid, Oregon Health Plan. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99487?

Payers that have issued tracked updates for CPT 99487 include: Blue Cross of Idaho, Maryland Medicaid, Oregon Health Plan.

How do I get notified when CPT 99487 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99487. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 99487?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 99487 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCS) - Added FQHC Billing Guidelines document

Update to Reimbursement for Remote Patient Monitoring Services: Self-Measured Blood Pressure Codes

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Added language about preventive exams and revised billing instructions for care coordination, VCS, CoCM, telehealth, and vaccines per CMS coding updates.

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification

Notice of intent – OHA will amend the Medicaid State Plan to increase fee-for-service primary care rates.

Prior authorization required