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CPT Codes

CPT Codes

CPT (CURRENT PROCEDURAL TERMINOLOGY) CONNECTED CODES

Billing codes and DESCRIPTIONS 

 

The CMS (Center for Medicare and Medicaid Services) has identified Chronic Care Management (CCM), Transitional Care Management (TCM) and Remote Patient Monitoring (RPM) as crucial components of primary care for patients.

This website provides CPT (Current Procedure Terminology) codes and descriptions for billing Chronic Care Management (CCM), Transitional Care Management (TCM) and Remote Patient Monitoring (RPM) services under CPT codes 99487, 99489, 99490 and 99491.


REMOTE PATIENT MONITORING (RPM)

CPT 99457 – $54

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

 CPT 99458 – $42 (new 2020)

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 – Can be added to CPT 99457

CPT-99453 – $21

Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc.) initial; setup and patient education on use of equipment.

CPT-99454 – $69

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 CPT 99091 – $59 (superseded by new 2019 RPM codes)

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.


COMMUNICATION TECHNOLOGY-BASED SERVICES



HCPCS G2012 – $10

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)

HCPCS G2010 – $13

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)


 CHRONIC CARE MANAGEMENT (CCM)


CPT 99490 – $42

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. The billing physician (or other appropriate billing practitioner) provides CCM services directly, that time counts towards the 20 minutes minimum time. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff may be counted towards the 20 minutes minimum time.

 CPT 99487 – $94

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
  • Establishment or substantial revision of a comprehensive care plan
  • Moderate or high complexity medical decision making
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

 CPT 99491 – $74.26 (New billing code 2020)

Chronic Care Management Services, at least 30 minutes of Physician or other qualified healthcare professional. Direct supervision only Physicians or nurse practitioners. Added to the CPT 99487 for the additional 30 minutes of the 60 minutes.

 CPT 99489 – $47

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). 

HCPCS G0506 – $64 

Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)

 G2058 – $38 (new 2020)

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) – Added to the CPT 99490 for the additional 20 minutes.


TRANSITIONAL CARE MANAGEMENT (TCM)


CPT 99495 – $188 (increase for 2020)

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT 99496 – $248 (increase for 2020)

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)


PRINCIPAL CARE MANAGEMENT (PCM)


G2064 – $92 (new 2020)

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.

 G2065 – $40 (new 2020)

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.

Updated 03/2020



In a general sense, Chronic Care Management encompasses any care provided by healthcare professionals to patients with chronic diseases and health conditions, such as fibromyalgia, diabetes, multiple sclerosis, lupus, and high blood pressure. The primary goal is to help patients, via therapies and interventions, to live with less pain related to their chronic conditions – to achieve a better quality of life through ongoing care and management of their conditions.



The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. In 2015, Medicare began paying separately under the Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions.



Only one practitioner may be paid for CCM services for a given calendar month. This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both).


For Medicare purposes, non-complex and complex CCM services share similar elements, differing only in the amount of clinical time and expertise required per calendar month.


Practitioner Eligibility Physicians and the following non-physician practitioners may bill CCM services: ● Certified Nurse Midwives ● Clinical Nurse Specialists ● Nurse Practitioners ● Physician Assistants NOTE: CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care. CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner), subject to applicable State law, licensure, and scope of practice.
The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM. Time spent directly by the billing practitioner or clinical staff counts toward the threshold clinical staff time required to be spent during a given month in order to bill CCM services. Non-clinical staff time cannot be counted toward the threshold.