Billing Codes

Chronic Care Management (CCM) is a care coordination service provided by practitioners and their clinical staff for patients with two or more chronic conditions who are at risk of death, acute exacerbation, decompensation or functional decline.
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CCM involves non-face-to-face clinical staff time that is performed outside the regular office visit including but not limited to clinical phone calls, medication management, referrals and other care coordination activities.
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Please reference the CMS Care Management fact sheets for the most recent guideline updates:
​https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management
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​Provider Eligibility
The eligible practitioners are as follows:
-Clinical Nurse Specialists
-Nurse Practitioners
-Physician Assistants
-Certified Nurse Midwives
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​Supervision
CCM services are assigned general supervision under the Medicare PFS. General supervision means when the service is not personally performed by the billing practitioner, it is performed under their overall direction and control although his or her physical presence is not required.
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​Place of Service
Medicare pays for CCM services under the same provisions as in-person physician services.
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​Initiating Visit
Providers must conduct a face-to-face exam for new patients or patients who have not been seen in the past 12 months. Most standard E/M services apply. A comprehensive care plan established, implemented, revised, or monitored
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Patient Consent
Patients must consent to CCM services to bill for reimbursement. The consent may be verbal or in writing but must be documented in the patient’s medical record.
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Patient Cost-Sharing
Patients are responsible for the standard Medicare Part B 20% cost-share for CCM services. It is recommended to verify coverage and benefit information for all other payers, including Medicare Advantage Plans.

99490 – CCM Base

Chronic care management services, at least 20 minutes of clinical staff time directed by a qualified healthcare professional, max unit of 1 per calendar month

99439 – CCM Additional (Extension of 99490)

Non-complex chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, max unit of 2 per calendar month

99487 – CCM Complex

Complex chronic care management services, at least 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following requirements (max unit of 1 per calendar month and can not be billed with 99439 during the same month):

99489 – CCM Complex Extra (Extension of 99487)

Complex chronic care management services, each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with no limit on units

99491 – CCM Provider

Chronic care management services provided personally by a physician or other qualified health care professional, at least 30 minutes of a physician or other qualified health care professional time, a max unit of 1 per calendar month, and no other CCM time-based codes may be billed during the month, except for 99437

99437 – CCM Provider Additional (Extension of 99491)

Chronic care management services provided personally by a physician or other qualified health care professional, each additional 30 minutes of physician or other qualified health care professional time, max unit of 2 per calendar month

G0506 – CCM Care Plan

Comprehensive assessment of and care planning for patients requiring chronic care management services. Can only be billed once ever WITH the office visit CPT code. Cannot be billed individually.

Note: CCIQ will trigger the G0506 when a care plan is uploaded or marked as “only available in EMR”. This is an indicator for the initial care plan and a way to check staff has billed G0506 with the office CPT code on a regular basis. For billing purposes, G0506 must be billed with the patient’s E&M code date exactly. The one-time G0506 code can not be billed separately from the E&M visit.

To remove G0506 from your billing report, choose “exclude” on the Care Plan Filter. To disable G0506 codes from triggering in CCIQ, please contact your client support representative.

Comprehensive care management services for a single high-risk disease, e.g., at least 30 minutes of time per calendar month with the following elements:
–one complex chronic condition lasting at least 3 months, which is the focus of the care plan
–the condition is of sufficient severity to place the patient at risk of hospitalization or have the cause of a recent hospitalization
–the condition requires the development or revision of a disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to co-morbidities
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​Provider Eligibility
The eligible practitioners are as follows:
-Clinical Nurse Specialists
-Nurse Practitioners
-Physician Assistants
-Certified Nurse Midwives
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​Supervision
PCM services are assigned general supervision under the Medicare PFS. General supervision means when the service is not personally performed by the billing practitioner, it is performed under their overall direction and control although his or her physical presence is not required.
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​Place of Service
Medicare pays for PCM services under the same provisions as in-person physician services.
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​Initiating Visit
Providers must conduct a face-to-face exam for new patients or patients who have not been seen in the past 12 months. Most standard E/M services apply.
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​Patient Consent
Patients must consent to PCM services in order to bill for reimbursement. The consent may be verbal or in writing but must be documented in the patient’s medical record.
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​Patient Cost-Sharing
Patients are responsible for the standard Medicare Part B 20% cost-share for CCM services. It is recommended to verify coverage and benefit information for all other payers, including Medicare Advantage Plans.

99424 – PCM Provider

Principal 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, max unit of 1 per calendar month, and cannot be billed with other PCM base codes

99425 – PCM Provider Additional (Extension of 99424)

Principal care management services, each additional 30 minutes of physician or other qualified health care professional time per calendar month, max unit of 2 per calendar month, and cannot be billed with other PCM base codes

99426 – PCM Base

Principal care management services for a single high-risk disease, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, max unit of 1 per calendar month

99427 – PCM Additional (Extension of 99426)

Principle care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, max unit of 2 per calendar month

Advanced Primary Care Management (APCM) introduces new codes for 2025 to support advanced primary care models, ensuring practitioners act as focal points for patient care. It emphasizes comprehensive and coordinated care through 13 service elements.
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For more information please click here: Advanced Primary Care Management (APCM)

G0556 (Base Level 1)

This is the first level of APCM services, designed for patients with complexity and one or fewer chronic conditions.

G0557 (Base Level 2)

This is the second level of APCM services, designed for patients with complexity and two or more chronic conditions.

G0558 (Base Level 3)

This is the third level of APCM services, designed for patients with complexity, two or more chronic conditions, and who are Qualified Medicare Beneficiaries.

G0568 (BHI Add on – CoCM Initial) – NEW as of January 1, 2026

Initial psychiatric collaborative care management, 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, with the following required elements:

G0567 (BHI Add on – CoCM Subsequent) – NEW as of January 1, 2026

Subsequent psychiatric collaborative care management, 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, with the following required elements:

G0568 (BHI Add on – BHI) – NEW as of January 1, 2026

Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

Chronic Remote Physiologic Monitoring (RPM) is a care management service that allows care providers and their staff to monitor patient-reported physiological data through interactive communication with the patient or caregiver.
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RPM involves managing and documenting clinical staff time for review and management of vital patient-reported data including blood pressure, glucose readings, pulse ox, weight, etc.
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Starting in 2019, 3 new codes were implemented which include separate reimbursement when at least 20 minutes of RPM care management time has been documented in a calendar month.
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​Provider Eligibility
The eligible practitioners are as follows:
-Clinical Nurse Specialists
-Nurse Practitioners
-Physician Assistants
-Certified Nurse Midwives
RPM services are assigned general supervision under the Medicare PFS. General supervision means when the service is not personally performed by the billing practitioner, it is performed under their overall direction and control although his or her physical presence is not required. (effective 1/1/2020)
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​Place of Service
Medicare pays for RPM services under the same provisions as in-person physician services.
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​Initiating Visit
Providers must conduct a face-to-face exam for new patients or patients who have not been seen in the past 12 months. Most standard E/M services apply.
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​Patient Consent
Patients must consent to RPM services in order to bill for reimbursement. The consent may be verbal or in writing but must be documented in the patient’s medical record.
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​Patient Cost-Sharing
As part of the PHE, RPM copays were waived for patients and telemedicine service was not subject to copay collections. This statute has expired and patients are responsible for the standard Medicare Part B 20% cost-share for RPM services. It is recommended to verify coverage and benefit information for all other payers, including Medicare Advantage Plans.
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​Concurrent Billing
Providers can bill for RPM & CCM within the same calendar month. However, time spent managing the patient cannot be counted toward the required time for both RPM and CCM. Billing both services requires at least 40+ minutes (20 minutes of CCM and 20 minutes of RPM).

99470 – RPM Intro (10 min) – NEW as of January 1st, 2026

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time, in a calendar month requiring one real-time interactive communication with the patient/caregiver during the calendar month; first 10 minutes

99457 – RPM Base (20 min)

Remote physiologic monitoring treatment management services, clinical staff/physician/ other qualified healthcare professional time, in a calendar month requiring one real-time interactive communication with the patient/caregiver during the calendar month; first 20 minutes (max unit of 1 per calendar month)

99458 – RPM Additional

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time, in a calendar month requiring one real-time interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (use in conjunction with 99457)

99453 – RPM Education

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial setup and patient education on the use of equipment (only billable once per episode of care)

(Starting 01/01/2026: Do not report 98975 for less than 2 days of cumulative monitoring during the 30 day period)

99445 – RPM Device Supply and Transmission – 2-15 days (NEW as of January 1st, 2026)

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in 30-day period

99454 – RPM Device Supply and Transmission – 16 to 30 days

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 16-30 days in a 30 day period

99091 – RPM Provider

Collection and interpretation of physiological 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, a max unit of 1 per calendar month and no other RPM time-based codes may be billed during the month

TCM is a service provided by healthcare providers and their staff to manage and coordinate care for patients after certain types of hospital discharges. These services are performed to avoid costly hospital readmissions and other adverse health events. CMS reimburses providers for timely follow-up and care transition management for recently discharged patients.
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​Provider Eligibility
The eligible practitioners are as follows:
-Clinical Nurse Specialists
-Nurse Practitioners
-Physician Assistants
-Certified Nurse Midwives
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​Supervision
Practitioners must furnish the required face-to-face visit under minimum direct supervision, subject to applicable State law, scope of practice, and the Medicare Physician Fee Schedule (PFS) incident to rules and regulations. Non-face-to-face services may be provided under general supervision. The practitioner must order services, maintain contact with auxiliary personnel, and retain professional responsibility for the services.
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​Service Settings
You may provide TCM services, beginning the day of the beneficiary’s discharge from one of these inpatient hospital settings:
— Inpatient Acute Care Hospital
— Inpatient Psychiatric Hospital
— Long-Term Care Hospital
— Skilled Nursing Facility
— Inpatient Rehabilitation Facility
— Hospital outpatient observation or partial hospitalization
— Partial hospitalization at a Community Mental Health Center
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After inpatient discharge, the beneficiary must return to their community setting:
— Home
— Domiciliary
— Rest home
— Assisted living facility
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​Components
1. Interactive Contact
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Within 2 business days following the beneficiary’s discharge, you must make an interactive contact with them and/or their caregiver via telephone, email, or face-to-face. Practitioners or clinical staff can address patient status and needs beyond scheduling follow-up care.
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2. Non-Face-to-Face Services
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Services Furnished by Physicians or NPPs:
— Obtain and review discharge information (for example, discharge summary or
continuity-of-care documents)
— Review the need for, or follow-up on, pending diagnostic tests and treatments
— Interact with other healthcare professionals who will assume or reassume care of the beneficiary’s system-specific problems
— Provide education to the beneficiary, family, guardian, and/or caregiver
— Establish or re-establish referrals and arrange for needed community resources
— Assist in scheduling required follow-up with community providers and services
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​Services Provided by Clinical Staff Under the Direction of a Physician or NPP:
— Communicate with agencies and community services the beneficiary uses
— Provide education to the beneficiary, family, guardian, and/or caretaker to support self-management, independent living, and activities of daily living
— Assess and support treatment adherence and medication management
— Identify available community and health resources
— Assist the beneficiary and family in accessing needed care and services
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3. Furnish one face-to-face visit within certain time-frames

99495 – TCM Moderate Complexity

Transitional care management services with moderate medical decision complexity require:

99496 – TCM High Complexity

Transitional care management services with high medical decision complexity require:

Remote Therapeutic Monitoring (RTM) refers to the use of technology to track and manage patients’ adherence to and progress with therapeutic treatments outside traditional clinical settings. RTM involves monitoring data such as medication usage, therapy exercises, or symptom management through digital devices or apps.
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This approach enables healthcare providers to proactively engage with patients, offering timely interventions based on real-time insights. RTM is commonly used in managing chronic conditions, post-surgical recovery, and physical rehabilitation. It improves patient outcomes by fostering consistent communication, enhancing treatment adherence, and identifying issues before they escalate, all while allowing patients to maintain their routines in their everyday environments.
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​Provider Eligibility
The eligible practitioners are as follows:
– Physician Assistants
– Clinical Nurse Specialists
– Mid Level Providers
– Qualified Healthcare Practitioners (PTs, OTs, and SLPs)
– Certain Non-physician Practitioners (NPPs)
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​Patient Consent
Patients must consent to RTM services in order to bill for reimbursement. The consent may be verbal or in writing, but must be documented in the patient’s medical record.

98975 – RTM Device Education

Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment (once only per episode of care, after 16 measurements received).

(Starting January 1, 2026: Do not report 98975 for less than 2 days of cumulative monitoring during the 30 day period)

98984 – RTM Device Respiratory Supply for 2-15 Days (NEW as of January 1st, 2026)

Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 2-15 days in a 30 day period

98976 – RTM Device Respiratory Supply for 16 – 30 days

Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 16-30 days in a 30 day period

98985 – RTM Device Musculoskeletal Supply for 2-15 Days (NEW as of January 1s, 2026)

Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30 day period

98977 – RTM Device Musculoskeletal Supply for 16 – 30 days

Remote therapeutic monitoring (e.g., therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 16-30 days in a 30 day period

98979 – RTM Intro (10 min) – NEW as of January 1, 2026

Remote therapeutic monitoring treatment management services, physician or other qualified healthcare professional time in a calendar month requiring at least one real-time interactive communication with the patient/caregiver during the calendar month; first 10 minutes

98980 – RTM Base (20 min)

Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one real-time interactive communication with the patient/caregiver during the calendar month; first 20 minutes (max of one unit per calendar month)

98981 – RTM Additional

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 (use in conjunction with 98980)

BHI is a care management service provided by healthcare providers and their staff to manage and coordinate care for patients with mental or behavioral health conditions. CMS reimburses physicians and non-physician practitioners for BHI services they supply to patients over a calendar month service period.
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​Supervision
BHI services that are not personally performed by the billing practitioner are assigned general supervision, although general supervision does not, by itself, make up a qualifying relationship between the billing practitioner and the other members of the care team. General supervision is defined as the service delivered under the overall direction and control of the billing practitioner, and their physical presence is not required during service provision.
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​Patient Consent
Patients must consent to BHI services in order to bill for reimbursement. The consent may be verbal or in writing but must be documented in the patient’s medical record.

99484 – BHI Base

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, direct by a physician or other qualified health care professional, per calendar month, with the following required elements, max unit of 1 per calendar month:
— Initial assessment or follow-up monitoring, including the use of applicable validated rating scale
— 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

99492 – BHI CoCM Initial

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, can only be billed once ever:
— Outreach to and engagement in the treatment of a patient directed by the treating physician or other
qualified healthcare professional
— Initial assessment of the patient, including administration of validated rating scales, with the
development of an individualized treatment plan
— Review by the psychiatric consultant with modifications of the plan if recommended
— Entering patients in a registry and tracking patient follow–up and progress using the registry, with
appropriate documentation, and participation in weekly caseload consultation with the psychiatric
consultant
— Provision of brief interventions using evidence-based techniques such as behavioral activation,
motivational interviewing, and other focused treatment strategies

99493 – BHI CoCM Subsequent

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, max unit of 1 per calendar month:
— Tracking patient follow–up and progress using the registry, with appropriate documentation
— Participation in weekly caseload consultation with the psychiatric consultant
— Ongoing collaboration with and coordination of the patient’s mental health care with the treating
physician or other qualified health care professional and any other treating mental health providers
— Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant
–Provision of brief interventions using evidence-based techniques such as behavioral activation,
motivational interviewing, and other focused treatment strategies
— Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with
patients as they achieve remission of symptoms and/or other treatment goals and are prepared for
discharge from active treatment

99494 – BHI CoCM Extra

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, no max limit of units

CPM is a care management service provided by healthcare providers and their staff to manage and coordinate care for patients with chronic pain conditions lasting over three months. CMS reimburses physicians and non-physician practitioners for CPM services they supply to patients over a calendar month service period. Care management services for CPM include: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.
Chronic pain is reclassified in ICS-11. Under the new classification, chronic pain is defined as “pain that persists or recurs for more than three months” and is differentiated into types of pain. Pain can be the sole or leading complaint, and needs special treatment and care.

Supervision
CPM services are to be provided by a physician or other qualified health care professional such as a PA, NP, or other eligible provider. These codes are “direct supervision” and may not be billed incident to a physician’s services under “general supervision”.
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​Patient Consent
Patients must consent to CPM services in order to bill for reimbursement. The consent may be verbal or in writing but must be documented in the patient’s medical record.

G3002 – CPM evaluation and initial

Chronic pain management and treatment, a monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate.

— Required initial face-to-face visit of at least 30 minutes provided by a physician or other qualified health professional

— First 30 minutes personally provided by a physician or other qualified health care professional, per calendar month. (When using G3002, 30 minutes must be met or exceeded.)

G3003 – CPM subsequent

Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month (list separately in addition to code for G3002). (When using G3003, 15 minutes must be met or exceeded.)

**NOTE: 2024 Updates for G0511 Codes will EXPAND to include RPM and multiple G0511 billing**

G0511 – CCM for RHC and FQHC (Will Be Sunset Coming 2025)

RHC or FQHC only, general care management, 20 minutes or more of clinical staff time, a max unit of 1 per calendar month

G0512 – BHI for RHC and FQHC

RHC or FQHC only, psychiatric collaborative care model (psychiatric COCM), 60 minutes or more of clinical staff time, a max unit of 1 per calendar month

An overview of commonly used billing codes supported within CCIQ and their national reimbursement amounts for 2026. Final reimbursement is payer-specific and subject to insurance verification.

Important Notes:

CMS: Federally Qualified Health Center Information

CMS: Rural Health Clinic Information