Reviewed by Jack Wright, Managing Partner 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…
Principal care management pays for monthly management of one high-risk chronic condition, where CCM requires two or more. Four codes carry it: 99424 and 99425 for practitioner time, 99426 and 99427 for clinical staff time, paying $54.11 to $87.51 in 2026. Per the CMS care management booklet (MLN909188), the condition must be expected to last…
Reviewed by Jack Wright, Managing Partner 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…
Reviewed by Jack Wright, Managing Partner 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…
Reviewed by Jack Wright, Managing Partner 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…
Reviewed by Jack Wright, Managing Partner 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…
Reviewed by Jack Wright, Managing Partner 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,…
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…
What a medical practice employee handbook needs, the 9 sections that carry the weight, and the HIPAA document mix-up found at a clinic our founder operates.
Whether to outsource medical billing is a make-or-buy decision, not a moral one. For most independent practices the honest answer turns on four things: your monthly claim volume, your payer mix, whether your revenue problem is actually a billing problem, and what the contract says about the day you want to leave. Here is the…
