RPM and CCM: Complementary Programs

Both RPM and CCM focus on improving care between office visits by leveraging connected technology and consistent patient engagement. Here’s how they complement each other:

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Chronic Care Management (CCM)

• CCM provides care coordination for Medicare beneficiaries with two or more chronic conditions expected to last at least 12 months or until the patient’s death.
• Services include non-face-to-face interactions such as care plan monitoring, medication management, and patient communication.

Remote Patient Monitoring (RPM)

• RPM allows providers to track physiological data—like blood pressure, blood glucose, and oxygen levels—in real-time using FDA-approved devices.
• This proactive monitoring helps providers intervene early, preventing complications that could lead to hospitalizations.

While both programs aim to enhance patient care, they differ in how they collect data and the associated billing codes.

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RPM CPT Codes for 2025

Medicare has established specific CPT codes to reimburse for RPM services. Providers must use these codes accurately to optimize reimbursement:

• 99453: Covers initial device setup and patient education.
  • Reimbursement: $19.73 (one-time fee per device, per patient).
  • Requirement: At least 16 days of data must be collected in a 30-day period.
• 99454: Covers device supply, data collection, and transmission.
  • Reimbursement: $43.03 (per patient, per 30-day period).
  • Requirement: At least 16 days of data must be collected during the billing period.
• 99457: Covers the first 20 minutes of clinical staff or provider time spent on RPM services, including patient communication.
  • Reimbursement: $47.88 (per 30-day period).
  • Requirement: Includes at least one interactive communication session with the patient (e.g., via phone, video, or text).
• 99458: Covers each additional 20-minute increment of RPM services beyond the initial 20 minutes billed under 99457.
  • Reimbursement: $38.50 (per additional 20 minutes).

CCM CPT Codes for 2025

CCM codes allow providers to bill for time spent on non-face-to-face care coordination activities. These include creating care plans, reviewing data, and communicating with patients.

• 99490: Covers 20 minutes of clinical staff time monitoring the care plan.
  • Reimbursement: $60.49.
• 99491: Covers 30 minutes of care provided directly by a physician or qualified healthcare professional.
  • Reimbursement: $82.18.
• 99437: Covers each additional 30 minutes of care provided by a physician or healthcare professional.
  • Reimbursement: $57.58.
• 99439: Covers each additional 20 minutes of care provided by clinical staff.
  • Reimbursement: $45.94.

Complex CCM Codes

For patients requiring more intensive care coordination, the following complex CCM codes may apply:

• 99487: Covers the first 60 minutes of care plan development or monitoring.
  • Reimbursement: $131.66.
• 99489: Covers each additional 30 minutes of complex care.
  • Reimbursement: $70.52.

Billing RPM and CCM Together

One of the most common questions providers ask is whether RPM and CCM can be billed together. The good news? Yes, they can—but with limitations.

Key Requirements for Billing RPM and CCM Together:

• RPM CPT code 99457 can be billed alongside CCM CPT code 99490 if the provider delivers at least 40 minutes of care in a calendar month.
  • Example: 20 minutes of RPM (99457) and 20 minutes of CCM (99490).
• Providers must ensure that time spent on RPM and CCM activities is distinct and not double-counted.

By integrating RPM and CCM, healthcare organizations can offer comprehensive care while maximizing revenue opportunities.

RPM Billing Requirements

To ensure accurate billing, providers must meet these Medicare RPM requirements:

1. FDA-Cleared Devices: All RPM devices must meet the FDA’s definition of a medical device and transmit data automatically (self-reported data does not qualify).
2. 16-Day Rule: To bill for CPT codes 99453 and 99454, patients must transmit data for at least 16 days in a 30-day billing cycle.
3. Interactive Communication: For CPT codes 99457 and 99458, providers must spend at least part of the care time in direct communication with the patient.
4. General Supervision: CPT codes 99457 and 99458 allow services to be provided under general supervision, meaning clinical staff can perform services under the direction of the billing provider.

Benefits of Outsourcing RPM and CCM Services

Managing RPM and CCM programs in-house can be resource-intensive, requiring significant staffing and administrative time. Outsourcing these services to a third-party provider can alleviate the burden while ensuring compliance and maximizing reimbursement.

Benefits of Outsourcing:

• Billing Accuracy: Third-party providers ensure that all billing requirements are met, reducing errors.
• Time Savings: Administrative tasks like data collection and reporting are handled externally, freeing up staff to focus on patient care.
• Improved Adherence: Many RPM companies provide FDA-cleared devices with built-in reminders to help patients meet usage requirements.
• Streamlined Workflows: Outsourcing integrates RPM and CCM into existing workflows with minimal disruption.
• Increased Revenue: Third-party providers can track billable time and alert organizations when patients are nearing billing thresholds.

At CCN Health, we offer comprehensive RPM and CCM solutions, from device integration to billing support, ensuring your programs run smoothly and profitably.