Reference
Glossary.
Key terms and definitions for remote patient monitoring, chronic care management, billing codes, and healthcare technology.
Programs & Services
Medicare care management programs and service types.
Remote Patient Monitoring (RPM)
A Medicare-reimbursable program that uses FDA-cleared devices to collect and transmit patient physiologic data (blood pressure, weight, glucose, SpO2) to clinical staff for review between office visits.
Learn moreChronic Care Management (CCM)
A Medicare program providing non-face-to-face care coordination for patients with two or more chronic conditions expected to last at least 12 months. Billed monthly based on clinical staff time.
Learn morePrincipal Care Management (PCM)
A Medicare program focused on managing a single high-complexity chronic condition. Requires 30+ minutes of clinical staff time per month and cannot be billed concurrently with CCM for the same patient.
Learn moreBehavioral Health Integration (BHI)
A Medicare program supporting behavioral health screening and collaborative care in primary care settings. Uses standardized screening tools like PHQ-9 and GAD-7.
Learn moreRemote Therapeutic Monitoring (RTM)
A Medicare program for monitoring therapy outcomes in musculoskeletal and respiratory conditions. Unlike RPM, RTM allows self-reported data and therapy-specific devices.
Learn moreTransitional Care Management (TCM)
A Medicare service for managing patients during the 30-day transition period following hospital discharge. Requires an interactive contact within 2 business days of discharge.
Annual Wellness Visit (AWV)
A preventive visit covered by Medicare that includes a health risk assessment, screening schedule, and personalized prevention plan. Not a physical exam.
Billing & Reimbursement
CPT codes, billing terminology, and reimbursement concepts.
CPT Code
Current Procedural Terminology — a standardized coding system maintained by the AMA used to report medical procedures and services to payers for reimbursement.
CPT 99453
RPM setup and patient education code. Billed once per patient enrollment episode. Covers initial device configuration, patient training, and enrollment documentation. Estimated reimbursement: ~$19.
Learn moreCPT 99454
RPM device supply and daily data transmission code. Billed monthly when a patient records and transmits physiologic data for 16 or more days in a 30-day period. Estimated reimbursement: ~$55/month.
Learn moreCPT 99457
RPM clinical review code covering the first 20 minutes of clinical staff time spent reviewing and acting on RPM data per calendar month. Estimated reimbursement: ~$48/month.
Learn moreCPT 99490
CCM services code for 20+ minutes of clinical staff time per calendar month spent on non-face-to-face care coordination for patients with 2+ chronic conditions. Estimated reimbursement: ~$62/month.
Learn moreMAC (Medicare Administrative Contractor)
Regional entities that process Medicare claims and may issue local coverage determinations. MAC policies can affect RPM/CCM billing requirements and vary by region.
CMS (Centers for Medicare & Medicaid Services)
The federal agency that administers Medicare, Medicaid, and the Children's Health Insurance Program. CMS sets reimbursement rates and program requirements for RPM, CCM, and related services.
Technology & Devices
Device types, connectivity standards, and platform terminology.
FDA Clearance
Regulatory authorization from the U.S. Food and Drug Administration confirming a medical device is substantially equivalent to an existing legally marketed device. Required for RPM devices used in Medicare billing.
Learn moreCellular-Connected Device
An RPM device with a built-in cellular SIM card that transmits data automatically over mobile networks without requiring a smartphone, Wi-Fi, or gateway device.
Learn moreContinuous Glucose Monitor (CGM)
A sensor worn on the body that measures interstitial glucose levels continuously (typically every 5 minutes), providing up to 288 readings per day. Used in RPM for diabetes management.
Learn morePulse Oximeter
A non-invasive device that measures peripheral oxygen saturation (SpO2) and pulse rate, typically via a fingertip sensor. Critical for monitoring COPD, heart failure, and respiratory conditions.
Learn moreSensorless Monitoring
Contactless monitoring using radar or ambient sensors that detect vital signs (heart rate, respiratory rate, motion) without any wearable device or patient interaction. Designed for memory care and dementia patients.
Learn moreFHIR (Fast Healthcare Interoperability Resources)
An HL7 standard for exchanging healthcare data electronically. FHIR R4 APIs enable EHR systems to share patient data with RPM platforms in a standardized format.
HL7
Health Level Seven International — a set of standards for the transfer of clinical and administrative data between healthcare applications. HL7 v2 messages and FHIR are used in EHR-RPM integrations.
ADT Events
Admission, Discharge, and Transfer messages generated by EHR systems when a patient's status changes. Used in RPM integrations to trigger monitoring protocol changes.
Clinical Concepts
Clinical metrics, conditions, and care models.
Time in Range (TIR)
The percentage of time a patient's glucose level stays within the target range (typically 70–180 mg/dL). A key CGM metric — consensus guidelines recommend >70% TIR for most adults with diabetes.
Learn moreICD-10 Code
International Classification of Diseases, 10th Revision — the diagnosis coding system used to identify qualifying conditions for RPM, CCM, and related programs. Required on claims for medical necessity.
Care Plan
A documented treatment plan including diagnoses, goals, interventions, and responsible providers. Required for CCM billing and used in RPM to set monitoring thresholds and alert parameters.
Collaborative Care Model
A team-based approach to behavioral health in primary care settings, involving the PCP, a behavioral health care manager, and a psychiatric consultant. Required for BHI billing under CoCM codes.
Learn moreAmbulatory Glucose Profile (AGP)
A standardized CGM report that visualizes glucose patterns over 14 days, showing median glucose, interquartile range, and time in range metrics. Recommended by the International Consensus on CGM.
Learn moreMean Arterial Pressure (MAP)
A calculated average arterial pressure during a single cardiac cycle. Normal range is 70–100 mmHg. Used as a hemodynamic indicator in blood pressure monitoring.
Learn moreRegulatory & Compliance
Compliance requirements, privacy laws, and regulatory frameworks.
HIPAA
Health Insurance Portability and Accountability Act — federal law requiring safeguards for protected health information (PHI). All RPM platforms must be HIPAA-compliant and execute BAAs with covered entities.
BAA (Business Associate Agreement)
A contract between a HIPAA-covered entity and a business associate (such as an RPM platform) that establishes permitted uses and safeguards for protected health information.
Telehealth Parity Law
State legislation requiring private insurers to reimburse telehealth services at the same rate as equivalent in-person services. Coverage of RPM under parity laws varies by state.
Learn moreInformed Consent
Patient authorization required before enrolling in RPM or CCM programs. Must document that the patient understands the service, potential cost-sharing, and their right to revoke consent at any time.
16-Day Transmission Requirement
CMS requirement for CPT 99454 billing: a patient must record and transmit physiologic data for at least 16 days within a 30-day billing period. Applies to RPM device supply claims.
Learn moreIncident-To Billing
A Medicare billing arrangement where services provided by clinical staff (RNs, MAs) can be billed under the supervising physician's NPI, typically at a higher rate. Applicable to RPM time-based codes.