CPT Billing Codes – Updated 2022

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CPT Billing Codes – Updated 2022

CMS has identified that preventative care management programs are crucial components of primary care for patients. This page provides CPT and HCPC codes and descriptions for billing for these services.

REMOTE PATIENT MONITORING (RPM) CPT BILLING CODE

CPT 99457 – $50
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; first 20 minutes

CPT 99458 – $41
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 – $19
Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc.) initial setup and patient education on use of equipment

CPT 99454 – $56
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 – $56
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
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
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 – $64 (Increased 2022)
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

CPT 99439 – $48 (Increased 2022)

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 – $134 (Increased 2022)
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
comprehensive care plan established, implemented, revised, or monitored
Moderate or high complexity medical decision making
First 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

CPT 99489 – $70
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 – $63
Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure)

TRANSITIONAL CARE MANAGEMENT (TCM) CPT BILLING CODE

CPT 99495 – $209 (Increased 2022)
Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT 99496 – $281 (Increased 2022)
Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

PRINCIPLE CARE MANAGEMENT (PCM)

CPT 99424 – $83 (Increased 2022)
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

CPT 99426 – $64 (Increased 2022)
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

BEHAVIORAL HEALTH INTEGRATION (BHI)

CPT 99484 – $45
Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional time, per calendar month, with the following required elements:

Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
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

CPT 99492 – $153
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

CPT 99493 – $149
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

CPT 99494 – $45
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 (List separately in addition to code for primary procedure)

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