Medicare reimburses remote care programs under specific CPT and G-codes. Understanding which codes apply — and how to document each one compliantly — is the difference between a program that pays for itself and one that generates audit risk. Below are the codes Avanti RMG manages for our clients.
| CPT Code | Description | Reimbursement |
|---|---|---|
| 99453 | Initial setup and patient education on use of monitoring device | $19.32 one-time |
| 99454 | Device supply with daily recordings — billed per 30-day period (requires 16+ days of data) | $50.15 / month |
| 99457 | First 20 minutes of monthly remote monitoring management and treatment by physician or clinical staff | $48.80 / month |
| 99458 | Each additional 20 minutes of monthly remote monitoring management (billed with 99457) | $39.65 / month |
Maximum monthly RPM revenue per patient (99454 + 99457 + 99458): ~$138.60/month
| CPT Code | Description | Reimbursement |
|---|---|---|
| 99490 | First 20 minutes of monthly CCM care coordination for patients with 2+ chronic conditions | $62.69 / month |
| 99439 | Each additional 20 minutes of monthly CCM care coordination (billed with 99490) | $47.44 / month |
| CPT Code | Description | Reimbursement |
|---|---|---|
| 99426 | First 30 minutes of monthly PCM for a single complex chronic condition | $61.34 / month |
| 99427 | Each additional 30 minutes of monthly PCM (billed with 99426) | $47.44 / month |
| G-Code | Description | Reimbursement |
|---|---|---|
| G0511 | General care management — covers CCM, PCM, and behavioral health integration for FQHC/RHC settings | $145.96 / month avg. |
Medicare allows certain programs to be billed together for the same patient in the same month — as long as the clinical time and activities are documented separately. Avanti RMG identifies every eligible code for each patient and manages the documentation to bill each one compliantly.
Medicare RPM is billed under four CPT codes: 99453 (one-time setup and patient education, $19.32), 99454 (device supply with daily recordings per 30-day period, $50.15/month), 99457 (first 20 minutes of monthly remote monitoring management, $48.80/month), and 99458 (each additional 20 minutes of management, $39.65/month).
CCM is billed under CPT 99490 (first 20 minutes of monthly care coordination, $62.69/month) and CPT 99439 (each additional 20 minutes of care coordination, $47.44/month). Patients must have two or more chronic conditions to qualify.
PCM is billed under CPT 99426 (first 30 minutes of monthly management for a single complex condition, $61.34/month) and CPT 99427 (each additional 30 minutes, $47.44/month). PCM focuses on a single high-complexity condition rather than multiple chronic conditions.
G0511 is a Medicare G-code used by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to bill for general care management services — including CCM, PCM, and behavioral health integration. It reimburses at a monthly average of $145.96.
Yes. Medicare allows billing RPM and CCM for the same patient in the same month, provided the clinical time and activities are documented separately. The services cannot double-count the same time or clinical effort. When combined, a single enrolled patient can generate $100–$150+ in monthly reimbursement.
The highest-value approach combines RPM (99454 + 99457 + 99458) with CCM (99490 + 99439) for eligible patients, generating $180–$200+ per patient per month. Avanti RMG identifies which patients qualify for which programs and manages the documentation to bill each compliantly.
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