Learn how remote care codes can enhance patient outcomes and significantly increase practice revenue while preparing for value-based care.
As healthcare evolves, practices are transitioning to models that prioritize outcomes, patient engagement, and financial sustainability. Remote care programs like Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and the newly introduced Advanced Primary Care Management (APCM) for 2025 are at the forefront of this transformation.
These programs, when combined with codes for Principal Care Management (PCM), Remote Therapeutic Monitoring (RTM), Principal Illness Navigation (PIN), and Continuous Glucose Monitoring (CGM), provide practices with a way to improve care delivery, enhance patient satisfaction, and generate sustainable revenue.
Here’s an in-depth look at how these codes work, why they matter, and how they can unlock significant growth for your practice:
1. Remote Patient Monitoring (RPM): Enhancing Outcomes with Real-Time Data
RPM allows practices to monitor patient vitals like blood pressure, glucose levels, and weight remotely using connected devices.
- 99453: $20 for initial setup and patient education.
- 99454: $56 monthly for 16 days of device data collection.
- 99457: $52 monthly for 20 minutes of non-face-to-face clinical staff time.
Why it matters:
RPM reduces hospital readmissions by 41 percent, improves medication adherence, and ensures timely interventions for at-risk patients. It empowers providers to make data-driven decisions and offer proactive care that saves lives.
2. Chronic Care Management (CCM): Proactive Support for Chronic Conditions
CCM focuses on patients with two or more chronic conditions, ensuring consistent care coordination and improving overall outcomes.
- 99490: $62 for 20 minutes of noncomplex care monthly.
- 99487: $132 for 60 minutes of complex care monthly.
- 99489: $70 for each additional 30 minutes.
Why it matters:
Chronic diseases account for 90 percent of U.S. healthcare costs. CCM improves health outcomes while reducing unnecessary ER visits and hospitalizations, offering better care for patients with long-term conditions.
3. Principal Care Management (PCM): Targeted Care for Single Conditions
PCM provides specialized care coordination for patients with a single chronic condition requiring focused management.
- 99424: $80.00 monthly for physician services.
- 99426: $63.00 for 30 minutes of clinical staff time.
Why it matters:
PCM supports high-risk patients with focused interventions, reducing the burden of managing complex conditions and preventing costly complications.
4. Advanced Primary Care Management (APCM): Bridging Fee-for-Service and Value-Based Care
APCM introduces population-based care concepts to fee-for-service providers, preparing them for the transition to value-based models.
- G0556: $15 per month for one chronic condition.
- G0557: $50 per month for two or more chronic conditions.
- G0558: $110 per month for QMB patients with two or more chronic conditions.
Why it matters:
APCM positions practices to serve as the central point for patient care coordination, improving outcomes, reducing hospitalizations, and aligning with the future of value-based care.
5. Remote Therapeutic Monitoring (RTM): Supporting Therapy Adherence
RTM tracks adherence to respiratory or musculoskeletal therapies, ensuring patients stay on track with their treatments.
- 98975: $17.35 for setup and education.
- 98976: $55.72 for 16 days of device monitoring.
Why it matters:
RTM enables providers to adjust treatment plans proactively, improving patient adherence and recovery outcomes.
6. Principal Illness Navigation (PIN): Guiding Patients Through Complex Care
PIN helps patients navigate challenging care plans for conditions like cancer or mental health.
- G0023: $61.00 for monthly navigation services.
- G0024: $46.00 for each additional session.
Why it matters:
PIN reduces patient stress, improves care plan adherence, and ensures timely follow-ups, which are critical for patients managing complex conditions.
7. Continuous Glucose Monitoring (CGM): Real-Time Diabetes Management
CGM tracks glucose levels continuously, offering actionable insights for diabetes care.
- 95250: $59.00 for setup and training.
- 95251: $47.00 monthly for data analysis and interpretation.
Why it matters:
CGM reduces diabetes complications by providing accurate data, helping patients and providers make informed decisions about treatment.
The Revenue Opportunity:
Combining remote care codes creates a comprehensive program for patients while significantly boosting practice revenue. For example:
- RPM + APCM: Generates $200+ per patient monthly.
- With 400 patients, a practice could earn over $80,000 in monthly revenue.
Conclusion:
Remote care codes like RPM, CCM, PCM, APCM, RTM, PIN, and CGM are more than just billing tools. They are critical for improving patient outcomes, enhancing care quality, and ensuring long-term financial sustainability for your practice.
Start leveraging these codes today to transform your practice into a patient-centered, revenue-generating powerhouse.
Learn More
Take the first step toward growth today.