CMS has proposed that starting January 1, 2027, remote physiologic monitoring and remote therapeutic monitoring may only be billed when furnished by clinical staff directly employed by the billing practice. If your RPM or RTM program runs through a third party vendor, and the rule finalizes as written this fall, you will have roughly eight…
Remote therapeutic monitoring (RTM) is RPM’s counterpart for therapy adherence and response: is the patient doing the home exercise program, using the inhaler, following the treatment plan, and how are they responding. The code family covers three types of therapeutic monitoring (musculoskeletal, respiratory, and cognitive behavioral therapy) and, like RPM, it sits at the center…
Remote physiologic monitoring (RPM) pays practices to track parameters like weight, blood pressure, and pulse oximetry between visits and act on the data. The code family has three components: education and setup, device supply, and treatment management. It is also the code family at the center of the CY 2027 proposed rule, which would require…
Principal care management (PCM) is the single-condition counterpart to CCM. Where chronic care management requires two or more chronic conditions, PCM covers monthly management of one high-risk condition. Per the CMS care management booklet (MLN909188), the condition must be expected to last at least three months and place the patient at significant risk of hospitalization,…
Advanced primary care management (APCM) is Medicare’s newest care management framework, effective January 1, 2025. It replaces the time thresholds that define CCM with a flat monthly payment set by patient complexity: G0556 pays $16.37 for patients with one or fewer chronic conditions, G0557 pays $53.78 for patients with two or more, and G0558 pays…
CPT 99491 is chronic care management billed on the practitioner’s own time: the first 30 minutes each calendar month that a physician or other qualified health care professional personally spends managing a patient with multiple chronic conditions. In 2026 it pays $89.18 nationally in the non facility setting, before geographic adjustment. The add on, CPT…
CPT 99487 and 99489 are the complex chronic care management codes. They pay substantially more than standard CCM ($144.29 for 99487 in 2026, nationally, non facility, before geographic adjustment) because they require more: 60 minutes of clinical staff time instead of 20, and moderate to high complexity medical decision making performed personally by the billing…
CPT 99439 is the add on code for chronic care management: each additional 20 minutes of clinical staff time in a calendar month, after the first 20 minutes billed under CPT 99490. In 2026 it pays $50.44 nationally in the non facility setting, before geographic adjustment, and Medicare caps it at 2 units per date…
CPT 99490 is the base code for chronic care management (CCM): the first 20 minutes of clinical staff time spent each calendar month managing a patient with multiple chronic conditions, under the general supervision of the billing practitioner. In 2026 it pays $66.13 nationally in the non facility setting, before geographic adjustment. It is billable…
If finalized, remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) could only be billed when the clinical staff doing the work are direct employees of the billing practice, starting January 1, 2027. That change comes from the CY 2027 Medicare Physician Fee Schedule proposed rule. It is a proposal, not a final rule. Here…
