CCM & RPM Reimbursement Changes in 2024

By Jack Whittaker | January 19, 2024

The most efficient and result-oriented method of managing chronic diseases is implementing Chronic Care Management (CCM) and Remote Patient Monitoring (RPM). Both of them come with their unique benefits and billing guidelines. The CCM and RPM reimbursement procedures have recently been updated in the 2024 final rule for the Physician Fee Schedule (PFS) by the Centers for Medicare & Medicaid Services (CMS).

Chronic Care Management (CCM) refers to the long-term planning and delivery of healthcare services to people with chronic illnesses, like asthma, diabetes, heart ailments, hypertension, cancer, and others. Continuous care allows easy management of symptoms, prevents complications, and improves general health, thereby decreasing severe health risks.

Remote Patient Monitoring (RPM) is a form of technically advanced chronic care that allows medical professionals to keep a consistent eye on their patients’ progress reports. Using specialized remote monitoring platforms, patient data is gathered and sent directly to medical professionals for proper assessment and care approach.

Table of Contents

Difference Between CCM & RPM

Both CCM and RPM are employed for acute, chronic, and post-operative care. RPM focuses on capturing vital health data including BP, heart rate, weight, body temperature, respiration rate, and more, and plays a critical role in managing chronic care. By using clinical software and connected devices to receive daily readings of patients’ vitals and getting alerted for any abnormalities/ warnings physicians and care coordinators can promptly intervene to avoid any complications and health emergencies.

In CCM, a wide range of treatment approaches are followed to manage and treat a patient’s chronic health condition. This comprehensive treatment approach focuses on:

Collaboration among healthcare services
Formulating personalized care plans
Improving patient engagement
Improving access to quality healthcare
Reducing health complications
Fostering well-being and a healthy lifestyle

All About CCM and RPM Billing

The CMS recognizes CCM as a valuable primary care service that helps improve patient health and care. Not only this, CMS also acknowledges the potential benefits of RPM in conjunction with the CCM.

CCM Billing

The eligibility for CCM includes RPM patients having two or more high-risk chronic diseases that are anticipated to continue for at least a year or until the patient passes away. The time allotted to caregiving under CCM can’t be doubled or duplicated. This means the amount of time needed and invested for each code should be met independently.

Brief Overview Of CCM CPT Codes With National Billing Average

99490

In order to qualify for this CPT code, a patient must have two chronic diseases at a minimum and see clinical staff for at least 20 minutes each month. It is not permitted to bill for 99490 and 99491 in the same month. With the average national payment rate of $61.57, the clinical staff is billed for the initial 20 minutes.

99439

99439 is used for each additional 20 minutes of clinical staff time per calendar month, directed by a physician or qualified healthcare professional. The average national payment rate is $47.16.

99491

The healthcare provider time for the initial 30 minutes is billed at an average national payment rate of $83.18.

99437

With the average national payment rate of $58.62, healthcare providers can time for an additional 30 minutes, with no limit.

99487

This is a Complex Chronic Care Management (CCCM) Code with an average national payment rate of $131.97, a minimum of 60 cumulative minutes are required during a 30-day period of remote consultation time in establishing or monitoring a treatment plan, with no limit.

99489

The average national payment rate for this Complex Chronic Care Management (CCCM) code is $71.06 and billed along with CPT 99487 for each additional 30 minutes of non-in-person consultation, with no limit.

G0511

For Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), this is a special payment code for 20 minutes each month, with no limit. $71.68 is the average national payment rate.

Brief Overview Of RPM CPT Codes With National Billing Average

99453

This CPT code indicates service initiation, addresses patient education, and device setup for monitoring devices that check vitals, including BP, weight, pulse, blood glucose, and respiratory flow rate.

99454

This code covers the cost of providing scheduled alert transmissions or daily recording of vitals on at least 16 unique days within 30 days. The average nationwide payment rate for this code is $46.50.

99457

The initial 20 minutes of treatment management are included in this code with an undefined amount of interactive remote communication sessions with the patient via text, phone, email, and video in a calendar month. The average nationwide payment rate is $48.14.

99458

This CPT code encompasses reimbursement for each additional 20 minutes of RPM sessions spent with/ on the patient a calendar month. Just like CPT 99457, the documentation of how the time is distributed is a must. The average national payment rate for this code is $38.64.

99091

Introduced in 2022, this code is the latest one to be enrolled and has more stringent criteria than its predecessors. It accounts for a minimum of 30 minutes for healthcare professionals to collect, analyze, and process data transmitted by patients over a given calendar month. At least one phone or email exchange involving medical management or monitor advice is covered under this CPT code.

The average nationwide payment rate is $52.71.

This code cannot be reported in conjunction with codes 99457, 99458, and other codes listed in the CPT guidelines for RPM.

Enhance CCM & RPM Experience With HealthArc

HealthArc is your reliable partner in enhancing chronic care and management of patient outcomes along with efficient billing. Our Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) software is designed to scale your healthcare results and make patient monitoring and management easy. Our suite of FDA-approved remote monitoring devices, patient communication and interaction capabilities, a dedicated customer success team, clinical software, physician dashboard, and billing capabilities provide a comprehensive solution.

Please request a free demo to learn about how we can help your organization achieve its care management goals. Also, feel free to talk to our team at +201 885 5571 for any queries about the CCM and RPM reimbursement changes.

Frequently Asked Questions (FAQs)

What are the latest CCM and RPM reimbursement changes?

Changes to Medicare reimbursement for CCM and RPM that have happened recently include new payment rates, new codes, and new billing rules that change how providers get paid for remote monitoring and non-face-to-face care coordination services. The goal of these changes is to better reflect how complicated care delivery is and to encourage more people to use them.

How do the new reimbursement rules impact Chronic Care Management (CCM)?

The new rules for reimbursement might change the amounts of money paid for CCM CPT codes, change the paperwork that needs to be done, and make billing based on time clearer. This will make sure that payments are more in line with the clinical work that goes into managing chronic conditions.

What’s changed with RPM reimbursement under Medicare?

RPM changes may include updated CPT codes, revised payment structures, and expanded guidance about what constitutes eligible monitoring activities. This impacts how practices bill for devices, patient data collection, and RPM care management time.

When did the CCM and RPM reimbursement changes take effect?

Implementation dates for reimbursement updates vary by payer. For Medicare, significant changes usually occur at the start of the calendar year or as dictated by the annual Physician Fee Schedule (PFS) changes. Providers should always verify the effective date on CMS or payer bulletins.

Are new CPT codes included in the reimbursement changes?

Yes, updates often add or change CPT codes for CCM, RPM, and other care management services to make it easier to keep track of time-based activities, data review, and patient engagement.

Do the reimbursement changes affect billing requirements for CCM?

New rules for reimbursement may change how CCM services are billed. For example, they may require documented time limits, levels of supervision, and parts of the care plan that are needed to support compliant billing.

How do RPM reimbursement changes affect device eligibility?

Updates to RPM reimbursement may make it clearer which devices and monitoring technologies are eligible for payment. These updates may include requirements for FDA-cleared devices and the types of clinical data that can be monitored and billed for.

Can CCM and RPM still be billed together after the reimbursement updates?

Yes, you can bill CCM and RPM in the same month if each service meets its documentation, time, and billing requirements under the new rules for reimbursement.

Will reimbursement changes improve revenue for CCM and RPM programs?

In most instances, to improve the overall reimbursement processes, healthcare organizations (culprits) will attempt to coordinate their payments to better reflect their delivery of care (and attempt to maximize revenue) through the improvement of their capabilities to successfully document and carry out clinical workflows and related services for all eligible patients.

How do these reimbursement changes affect patient cost sharing?

Under Medicare, patient coinsurance may still apply. Changes to reimbursement rates may influence cost-share amounts, but patient responsibility depends on individual coverage and supplemental plans. Providers should verify with payers.

Are RPM time thresholds for billing affected by the reimbursement updates?

Updated reimbursement guidance may redefine minimum time requirements for RPM services and how time is tracked, billed, and documented—emphasizing accurate time capture for remote clinical engagement.

What documentation is required to support CCM and RPM reimbursement after the changes?

Providers must keep detailed records of clinical time, data review activities, device usage, care plan updates, and patient interactions that meet payer requirements and guarantee compliant reimbursement.

Can non-physician practitioners bill CCM and RPM under the new reimbursement rules?

Yes, qualified non-physician practitioners such as nurse practitioners, physician assistants, and clinical nurse specialists can generally bill CCM and RPM services, subject to updated supervision and billing guidelines.

How should practices prepare for CCM and RPM reimbursement changes?

To prepare, practices should:

Review updated CPT code guidelines
Update documentation and EHR workflows
Train staff on revised billing requirements
Verify payer-specific rules and implementation dates

Where can providers find official guidance on CCM and RPM reimbursement changes?

Providers should consult the latest Medicare Physician Fee Schedule (PFS), CMS transmittals, and payer bulletins. Practice management resources and professional coding guides also provide interpretation and examples.

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