Remote Care Reimbursement & Coding Guide
Discover the latest developments for 2024
Take a closer look at the intricate web of remote care opportunities with Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Transitional Care Management (TCM), Behavioral Health Integration (BHI), Principal Care Management (PCM) and Remote Therapeutic Monitoring (RTM) as supported by CMS.
CMS Reimbursement Opportunities Overview
CPT 99453 – $19.32
Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment.
CPT 99454 – $50.15
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s)or programmed alert(s) transmission, each 30 days.
CPT 99457 – $48.80
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
CPT 99458 – $39.65
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes
CPT 99091 – $54.22
Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.
Chronic Care Management (CCM) Billing Codes:
CPT 99490 – $62.69
Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
Comprehensive care plan established, implemented, revised, or monitored
CPT 99439 – $47.44
Chronic care management services, each additional 20 minutes of clinical staff time directed by
a physician or other qualified health care professional, per calendar month (limit 2x during
service period)
CPT 99487 – $133.18
Complex chronic care management services, with the following, required elements:
Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
comprehensive care plan established, implemented, revised, or monitored,
Moderate or high complexity medical decision making
First 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
CPT 99489 – $70.49
Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
G0506 – $62.01
Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)
Remote Therapeutic Monitoring (RTM) Codes:
CPT 98975 - $19.32
Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment.
CPT 98976 - $50.15
Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days.
CPT 98977 - $50.15
Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days.
CPT 98980 - $49.48
Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.
CPT 98981 - $39.65
Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure).
Communication Technology-Based Services (Virtual Check-in) CPT Billing Codes:
G2012 – $14.23
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion)
G2010 – $12.20
Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment)
Transitional Care Management (TCM) CPT Billing Codes:
Principal Care Management (PCM) Billing Codes:
CPT 99424 – $81.33
Comprehensive care management services for a single high-risk disease, at least 30 minutes of physician or other qualified health care professional time per calendar month.
CPT 99426 – $61.34
Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Behavioral Health Integration (BHI) Billing Codes:
CPT 99484 – $43.04
Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional time, per calendar month, with the following required elements:
Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation
Continuity of care with a designated member of the care team
CPT 99492 – $150.80
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional.
CPT 99493 – $142.67
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional
CPT 99494 – $57.95
Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure).