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  • Saman Balkhanian

Connected Care Billing Codes -

The CMS has identified Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) as crucial components of primary care for patients. This page provides CPT codes and descriptions for billing chronic care management (CCM), remote patient monitoring (RPM) and Principal Care Management services under CPT codes 99487, 99489, 99490 and 99491.


REMOTE PATIENT MONITORING (RPM) CPT BILLING CODE


CPT 99457 – $54 (new 2019) 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


CPT 99453 – $21 (new 2019) 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 (new 2019) 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CPT 99091 – $59 (superseded by new 2019 RPM codes) Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by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 (VIRTUAL CHECK-IN) CPT BILLING CODE


HCPCS G2012 – $10 (new 2019) 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 Code G2010 – $13 (new 2019) 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 BILLING CODE

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, 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


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)


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 declineEstablishment 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 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)



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.

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