RPMRemote Patient Monitoring
Connected physiologic data between visits
1. Who can provide the service
Physicians and eligible nonphysician practitioners who can bill evaluation and management services. Qualified clinical or auxiliary staff may support permitted work under required supervision; contracted staffing does not independently confer billing eligibility.
2. Medical necessity & physician order
An acute or chronic condition for which transmitted physiologic measurements inform treatment. Record the diagnosis, clinical rationale, monitoring plan, established treatment relationship and consent. InstaMD captures clinician authorization/order in its workflow; CMS does not require a separate RPM order or ordering-provider information on the claim. Other payer rules may differ.
Insurance reimbursement
Medicare Part B reimburses eligible, medically necessary services when all code requirements are met. Medicare Advantage, Medicaid and commercial coverage, authorization, network rules and rates must be checked with the plan. Traditional Medicare deductible and typically 20% coinsurance apply unless another coverage or protection applies.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| 99453 | Device setup and patient education | Initial setup and education, with at least 2 qualifying data days in the 30-day period; confirm payer rules. |
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| 99445 / 99454 | Device supply and automatic transmission | 99445: 2–15 qualifying days; 99454: at least 16 qualifying days in 30 days. Select one, not both. |
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| 99470 / 99457 | Treatment management with interactive communication | 99470: 10–19 minutes; 99457: first 20 minutes per calendar month. Do not report together. |
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| 99458 | Additional treatment-management time | Each additional 20 minutes with 99457; not an add-on to 99470. |
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4. Billing & documentation
Bill actual furnished components under the eligible practitioner and enrolled billing entity. Retain device eligibility, transmitted-day counts, setup records, clinical review, treatment decisions and live interactive patient/caregiver communication. Separate 30-day device periods from calendar-month management. Do not multiply device-supply claims for multiple devices. Verify practitioner exclusivity and current edits before submission.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
PCMPrincipal Care Management
One serious, high-risk chronic condition
1. Who can provide the service
An eligible physician or qualified practitioner responsible for the principal condition. Personal practitioner work and directed clinical-staff work use different code pathways; qualified contracted staff may support the latter under applicable supervision.
2. Medical necessity & physician order
Document a single complex condition expected to last at least 3 months, its substantial risk, and the need for disease-specific planning and active management. Explain why usual follow-up is insufficient, including treatment adjustment or unusual management complexity. Capture clinician authorization, consent and the required initiating assessment.
Insurance reimbursement
Medicare Part B reimburses eligible, medically necessary services when all code requirements are met. Medicare Advantage, Medicaid and commercial coverage, authorization, network rules and rates must be checked with the plan. Traditional Medicare deductible and typically 20% coinsurance apply unless another coverage or protection applies.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| 99424 + 99425 | Practitioner time | First 30 minutes + each additional 30 minutes per calendar month. |
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| 99426 + 99427 | Directed clinical-staff time | First 30 minutes + each additional 30 minutes per calendar month. |
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4. Billing & documentation
Select the pathway matching who performed the work. Record condition-specific goals, care coordination, date, activity, duration and staff identity. Do not combine practitioner and staff pathways for the same work or reuse RPM minutes. Coordinate with primary care and other specialists; check CCM/APCM, same-condition and same-period restrictions rather than assuming blanket compatibility.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
CHICommunity Health Integration
Address barriers that interfere with care
1. Who can provide the service
A physician or eligible practitioner directs trained or certified auxiliary personnel, such as community health workers. A contracted community organization may supply personnel when incident-to, supervision, training and state requirements are met.
2. Medical necessity & physician order
At an initiating visit, the practitioner identifies a barrier that materially limits diagnosis or treatment and connects it to the care plan. Examples include transportation, food access, medication affordability or health literacy. Document the barrier, planned intervention, practitioner authorization and patient consent.
Insurance reimbursement
Medicare Part B reimburses eligible, medically necessary services when all code requirements are met. Medicare Advantage, Medicaid and commercial coverage, authorization, network rules and rates must be checked with the plan. Traditional Medicare deductible and typically 20% coinsurance apply unless another coverage or protection applies.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| G0019 | Base monthly CHI service | First 60 minutes per calendar month. |
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| G0022 | Additional CHI service | Each additional 30 minutes; requires the base service. |
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4. Billing & documentation
These are HCPCS codes. Bill through the eligible supervising practitioner arrangement, not solely because a vendor made outreach calls. Record actual qualifying work and progress against the barrier. Check applicable time-reporting conventions, monthly limits and edits. CHI and PIN require distinct purposes and nonduplicated work when both are furnished.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
PINPrincipal Illness Navigation
Navigate a serious illness and complex care pathway
1. Who can provide the service
An eligible physician or practitioner directs appropriately trained or certified auxiliary personnel. Contracted navigators must meet role, competency, supervision and state requirements. Behavioral-health peer-support navigation has a separate qualified-personnel pathway.
2. Medical necessity & physician order
An initiating visit establishes a serious, high-risk illness, expected duration of at least 3 months, and the need for navigation and a disease-specific care plan. Document the clinical risk, practical navigation needs, practitioner authorization and consent; a diagnosis alone is not enough.
Insurance reimbursement
Medicare Part B reimburses eligible, medically necessary services when all code requirements are met. Medicare Advantage, Medicaid and commercial coverage, authorization, network rules and rates must be checked with the plan. Traditional Medicare deductible and typically 20% coinsurance apply unless another coverage or protection applies.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| G0023 + G0024 | Principal illness navigation | First 60 minutes + each additional 30 minutes per calendar month. |
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| G0140 + G0146 | PIN peer support | First 60 minutes + each additional 30 minutes for the qualifying behavioral-health peer-support model. |
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4. Billing & documentation
Use HCPCS codes for the actual navigation model delivered. Retain person-centered planning, referral follow-through, time and personnel records. Keep peer-support qualifications documented. Verify base/add-on rules, code-specific reporting thresholds and concurrent services. Do not count the same coordination activity toward PIN and another program.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
BHIBehavioral Health Integration
Behavioral care connected to the treating practice
1. Who can provide the service
General BHI: treating physician or eligible practitioner with qualified clinical staff. Psychiatric collaborative care (CoCM) additionally needs a behavioral health care manager and psychiatric consultant; contracted team members must meet those qualifications.
2. Medical necessity & physician order
Document a behavioral-health condition and treatment need, validated assessment, care plan, consent and initiating visit when required. Screening alone does not establish a complete monthly BHI service.
Insurance reimbursement
Eligible Medicare Part B services are reimbursable; deductible and coinsurance generally apply. Check plan coverage and avoid duplicate payment for the same behavioral-health work.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| 99484 | General BHI | At least 20 minutes of clinical-staff work per calendar month. |
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| 99492 / 99493 / 99494 | Psychiatric CoCM | 70 minutes initial month / 60 subsequent / 30 additional; apply CPT reporting rules. |
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| G0570; G0568 / G0569 | 2026 APCM-related pathways | Non-time-based BHI / CoCM add-ons require an APCM base and all model requirements. |
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4. Billing & documentation
Bill the supported model, with team roles, assessments, care-plan updates and qualifying activity documented. Review APCM-related code selection and duplication edits. A separate G0323 pathway exists for qualified clinical psychologists or clinical social workers.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
MNTMedical Nutrition Therapy
Individualized nutrition treatment
1. Who can provide the service
A registered dietitian or other nutrition professional meeting Medicare qualifications, including a properly credentialed contracted provider.
2. Medical necessity & physician order
A physician referral is required for Medicare. Qualifying diagnoses include diabetes, eligible kidney disease or kidney transplant within the past 36 months. Heart failure, hypertension or obesity alone does not establish this Medicare benefit.
Insurance reimbursement
Part B generally covers 3 hours in the first calendar year and 2 hours annually thereafter. Additional medically necessary hours require a new referral for a change in condition or treatment. Eligible covered MNT has no patient deductible or coinsurance. Dialysis-facility nutrition care is part of the dialysis benefit.
3. CPT / HCPCS rules
| Code | Service | Core rule |
|---|
| 97802 / 97803 | Individual assessment / follow-up | Each 15 minutes. |
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| 97804 | Group MNT | Each 30 minutes, not 15 minutes. |
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| G0270 / G0271 | Additional individual / group services | 15-minute individual / 30-minute group units following qualifying referral and benefit rules. |
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4. Billing & documentation
Use the enrolled nutrition professional’s appropriate billing/reassignment arrangement. Retain referral, diagnosis, assessment, treatment plan, minutes, units and annual benefit tracking. Verify other payer rules and same-day diabetes education restrictions.
Abbreviated code summaries; confirm current code instructions, payer policy and edits. CMS guidance ↗
