CPT codes for Medicare care management, explained.
Time thresholds, documentation and common billing mistakes for the codes behind CCM, PCM, RPM, RTM and TCM. Your practice bills these codes; Zenith supplies the clinical staff time. Educational summaries, not billing advice.
Chronic Care Management
- CPT 99490CCM, first 20 minutes20 minutes of clinical staff time per calendar month~$66
- CPT 99439CCM add-on, extra 20 minEach additional 20 minutes beyond the first 20~$46
- CPT 99487Complex CCM, first 60 min60 minutes of clinical staff time per calendar month~$132
- CPT 99489Complex CCM add-onEach additional 30 minutes beyond the first 60~$70
- CPT 99491CCM by the physician30 minutes personally performed by the practitioner per month~$83
- CPT 99437CCM add-on by physicianEach additional 30 minutes of practitioner time~$59
Principal Care Management
- CPT 99424PCM by physician, 30 min30 minutes of practitioner time per calendar month~$88
- CPT 99425PCM add-on by physicianEach additional 30 minutes of practitioner time~$61
- CPT 99426PCM by staff, 30 min30 minutes of clinical staff time per calendar month~$68
- CPT 99427PCM add-on by staffEach additional 30 minutes of clinical staff time~$54
Remote Patient Monitoring
- CPT 99453RPM device setupSetup and education, no monthly minute threshold~$20
- CPT 99454RPM device supplyAt least 16 days of transmitted readings in 30 days~$52 per month
- CPT 99457RPM management, 20 min20 minutes per calendar month with interactive communication~$52
- CPT 99458RPM add-on, extra 20 minEach additional 20 minutes beyond the first 20Varies by locality
Remote Therapeutic Monitoring
- CPT 98975RTM device setupSetup and education, no monthly minute threshold~$22
- CPT 98976RTM respiratory supplyAt least 16 days of data in a 30-day period~$47 per month
- CPT 98977RTM musculoskeletalAt least 16 days of data in a 30-day period~$40 per month
- CPT 98980RTM management, 20 min20 minutes per calendar month with interactive communicationVaries by locality
- CPT 98981RTM add-on, extra 20 minEach additional 20 minutes beyond the first 20Varies by locality