If you’re looking to launch new workflows with care management services; remote patient monitoring (RPM); or generalized telehealth services, this resource is for you. This list of telehealth CPT and HCPCS codes gives you a quick overview of what options are available to your health organization, whether you’re an FQHC, community-based organization or private practice. 

IN THIS GUIDE:

  • Chronic Care Management (CCM) Codes
  • Principal Care Management (PCM) Codes
  • Transitional Care Management (TCM) Codes
  • Behavioral Health Integration (BHI) Codes
  • Psychiatric Collaborative Care Model (CoCM) Codes
  • Remote Patient Monitoring (RPM) Codes
  • Virtual Communication Services (VCS) + Virtual Check-In Codes
  • E-visit codes

 

Chronic Care Management (CCM) Overview:

CCM is a U.S. Center for Medicare and Medicaid Services (CMS) program designed for patients with two or more chronic conditions. The main purpose is to increase the value of care and allow providers, patients and other members of the care team to stay connected and carry out steps that are in the best interest of the patient. 

CPT code 99490:

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. Fifteen of these minutes should involve work done directly by the billing practitioner. 

CPT code 99491:

Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month. 

*This code only includes time spent directly by the billing practitioner. Clinical staff time does not count toward the time requirement for this code. 

The two codes above require the following 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 code 99487: 

Complex CCM, which requires the following elements: 

  • Establishment or substantial revision of a comprehensive care plan
  • Moderate or high complexity medical decision making
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

*FQHCs should always bill for the general care management HCPCS code G0511 when billing for any care management service.

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Principal Care Management (PCM) Overview:

This program has many elements similar to CCM, but devotes attention to patients with a single high-risk disease, or one of a higher level of complexity that requires special attention.

HCPCS code G2064: 

Requires at least 30 minutes of PCM services to be furnished by a physician or a non-physician during a calendar month. 

HCPCS code G2065: 

Requires at least 30 minutes of PCM services to be furnished by clinical staff under the direct supervision of a physician or non-physician during a calendar month.

*RHCs and FQHCs should use the general care management HCPCS code G0511, either with or without other payable services on RHC and FQHC claims.

 

MORE RESOURCES AVAILABLE TO YOU: 

The CCM vs. PCM Guide: How to Choose

 

The Power of PCM for Specialty Care

 

Why PCM Matters for FQHC Patient Populations

 

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Transitional Care Management (TCM) Overview:

This program is for recently discharged patients to monitor any declines in health and ensure a steady recovery to avoid rehospitalization. 

CPT code 99495:

Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge.

CPT code 99496:

Communication (direct contact, telephone, electronic) with patient and/or caregiver within two business days of discharge; medical decision making of high complexity during the service period; face-to-face visit within seven calendar days of discharge.

*FQHCs and RHCs should bill G0511 for TCM. Clinicians of these health centers may also concurrently bill CCM and TCM in the same month by using this same code.

 

MORE RESOURCES AVAILABLE TO YOU:

Harness New TCM + CCM Clinical Workflow

 

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Behavioral Health Integration (BHI) Overview:

BHI is another care management program designed to facilitate the integration of mental health and substance abuse treatment into primary care and transform results for patients suffering from these conditions. 

CPT code 99484: 

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

*FQHCs should bill general care management HCPCS code G0511 for BHI.

 

Sub-category of BHI: Psychiatric Collaborative Care Model (CoCM) Overview: 

CoCM is a care model of BHI that introduces two other key members to the care team: a Behavioral Health Care Manager and a Psychiatric Consultant. 

 

CPT code 99492: 

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 code 99493:

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 code 99494: 

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

Newly added HCPCS code G2214: 

*Added to reflect shorter increments of time spent with the patient 

Initial or subsequent psychiatric collaborative care management, first 30 minutes in a 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.

*FQHCs and RHCs should bill G0512 for CoCM.

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Remote Patient Monitoring (RPM) Overview:

CPT code 99453: 

Remote monitoring of physiological parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.

CPT code 99454: 

Remote monitoring of physiological parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; each 30 days.

CPT code 99091: 

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, each 30 days.

CPT code 99457: 

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; initial 20 minutes) 

CPT code 99458

Every additional 20 minutes of services needed to carry out responsibilities as detailed in CPT 99457 

*FQHCS and RHCs should bill RPM as an activity through a care management service, such as CCM or PCM. 

For RPM services billed as hospital outpatient services: 

  • CPT code 99453 becomes APC 5012
  • CPT 99454 becomes APC 5741

 

MORE RESOURCES AVAILABLE TO YOU:

Using RPM and PCM to Promote Patient Self Management

 

How to Leverage RPM to Improve Patient Outcomes & Engagement

 

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Virtual Communication Services (VCS) + Virtual Check-In’s Overview:

VCS is used for brief discussions with patients in between appointments to clear up any questions or to see if next steps need to be taken. Inquiries must be initiated by the patient through a digital or telephonic medium. 

HCPCS code G2012:

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 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:

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. No minimum time requirement.

*FQHCs should bill HCPCS code G0071, which is the equivalent of the two HCPCS codes above.

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E-Visits Overview:

This is patient-initiated communication via a patient portal that solicits evaluation and management services by the physician. Clinicians who can independently bill Medicare for evaluation and management services are allowed to bill for the following codes: 

CPT code 99421:

Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes

CPT code 99422:

Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes 

CPT code 99423:

Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes.

 

Clinicians who are not permitted to independently bill for evaluation and management visits (ex: occupational therapists, speech language pathologists, clinical psychologists) can also furnish e-visits by billing the following codes: 

HCPCS code G2061:

Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days. Time over the seven days accumulates to 5-10 minutes.

HCPCS code G2062:

Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days. Time over the seven days accumulates to 11–20 minutes.

HCPCS code G2063:

Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days. Time over the seven days accumulates to 21 or more minutes.

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