CPT 99489
Global ZZZ ActiveCplx chrnc care ea addl 30
CPT 99489 Billing & Documentation Guide
CPT code 99489 (Cplx chrnc care ea addl 30) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1, a non-facility practice expense RVU of 1.27, and a malpractice RVU of 0.07, a total non-facility RVU of 2.34 and facility RVU of 1.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $80.36, though rates vary from $71.04 to $99.5 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99489, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99489 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 10 units of 99489 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99489
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1 | 1 |
| Practice Expense RVU | 1.27 | 0.24 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 2.34 | 1.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99489
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $86.06 | $45.35 | $81.71 - $99.5 | 29 |
| Florida | $80.51 | $46 | $77.47 - $83.47 | 3 |
| Georgia | $76.72 | $43.9 | $74.03 - $79.41 | 2 |
| Illinois | $78.97 | $45.73 | $75.78 - $81.63 | 4 |
| Michigan | $76.53 | $44.22 | $74.77 - $78.28 | 2 |
| North Carolina | $74.47 | $42.37 | $74.47 - $74.47 | 1 |
| New York | $85.49 | $47.11 | $75.34 - $90.32 | 5 |
| Ohio | $74.49 | $43.08 | $74.49 - $74.49 | 1 |
| Pennsylvania | $77.75 | $44.06 | $74.55 - $80.95 | 2 |
| Texas | $77.52 | $43.65 | $74.17 - $80.42 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99489
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99489 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99489
What does CPT code 99489 mean? +
CPT code 99489 represents: Cplx chrnc care ea addl 30. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99489? +
The 2026 Medicare national average non-facility payment for CPT 99489 is $80.36. Rates range from $71.04 to $99.5 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99489? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99489? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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