RPM, CCM & PCM Reimbursement Guide (2026)
The current code sets with approximate national-average rates, plus a calculator to estimate your practice's revenue.
Remote Patient Monitoring Codes
| CPT | What it covers | Frequency | Approx. avg* |
|---|---|---|---|
| 99453 | Setup & patient educationInitial setup and education on the monitoring device(s). | Once per episode | $20 |
| 99454 | Device supply + data (16+ days)Device supply with daily recordings; requires 16 or more days of readings. | Each 30 days | $45–50 |
| 99445New 2026 | Device supply + data (2–15 days)Device supply when only 2–15 days of readings are collected.Use instead of 99454 when fewer than 16 days of data are collected. | Each 30 days | Varies |
| 99470New 2026 | First 10 minutes of managementManagement with interactive communication; 10–19 total minutes.Can't be billed with 99457 in the same month. | Monthly | $10–26 |
| 99457 | First 20 minutes of managementTreatment management requiring interactive communication. | Monthly | $48–52 |
| 99458Add-on | Each additional 20 minutesAdd-on to 99457 for each additional 20 minutes.Only after the first 20 minutes (99457) are met. | Monthly (add-on) | $41 |
| 99091 | Physician data interpretationCollection and interpretation of physiologic data by a physician or QHP. | Each 30 days | $50–56 |
Chronic Care Management Codes
| CPT | What it covers | Frequency | Approx. avg* |
|---|---|---|---|
| 99490 | CCM, first 20 minutesClinical staff time directed by a physician or QHP; first 20 minutes. | Monthly | $60–62 |
| 99439Add-on | CCM, each additional 20 minutesAdd-on to 99490 for each additional 20 minutes (up to 2 units). | Monthly (add-on) | $45–48 |
| 99491 | CCM by physician or QHP30 minutes provided personally by the physician or QHP. | Monthly | $82–86 |
| 99437Add-on | CCM by physician or QHP, each additional 30 minutesAdd-on to 99491 for each additional 30 minutes of physician or QHP time. | Monthly (add-on) | $58–60 |
| 99487 | Complex CCM, 60 minutesComplex CCM requiring moderate or high-complexity decision making. | Monthly | $130–134 |
| 99489Add-on | Complex CCM, each additional 30 minutesAdd-on to 99487 for each additional 30 minutes. | Monthly (add-on) | $70–72 |
Principal Care Management Codes
| CPT | What it covers | Frequency | Approx. avg* |
|---|---|---|---|
| 99424 | PCM by physician, first 30 minutes30 minutes personally spent by the physician or QHP managing one complex condition. | Monthly | $84 |
| 99425Add-on | PCM by physician, each additional 30 minutesAdd-on to 99424 for each additional 30 minutes of physician or QHP time. | Monthly (add-on) | $60 |
| 99426 | PCM by clinical staff, first 30 minutes30 minutes of clinical staff time directed by the billing practitioner. | Monthly | $63 |
| 99427Add-on | PCM by clinical staff, each additional 30 minutesAdd-on to 99426 for each additional 30 minutes of clinical staff time. | Monthly (add-on) | $49 |
*Approximate 2026 Medicare national averages. Actual payment varies by payer, locality and documentation. Not billing advice; verify against the current Medicare Physician Fee Schedule. CPT® is a registered trademark of the American Medical Association.
Estimate Your Revenue
Pick a program, enter how many patients you have and adjust the assumptions. For an eligible patient, RPM can be billed in the same month as CCM or PCM when the time counted toward each is distinct.
Device Supply
Days with readings in the month. Each patient is billed one or the other.
180 of 200 patients billed for device supply
Management Time
Care team time with the patient in the month. One or the other per patient.
170 of 200 patients billed for management
Additional Time
Add-ons for patients who already reached 20 minutes.
Physician Interpretation
Physician or QHP review of the readings.
≈ $357,432 per year, all programs combined
By CPT Code
RPM
- 99453 Setup$400 1%
- 99454 Device, 16+ days$7,680 26%
- 99445 Device, 2–15 days$300 1%
- 99457 First 20 min$7,650 26%
- 99458 Extra 20 min$2,460 8%
- 99470 First 10 min$360 1%
- 99091 Interpretation$0 0%
CCM
- 99490 First 20 min$6,222 21%
- 99439 Extra 20 min$2,208 7%
- 99491 Physician 30 min$0 0%
- 99487 Complex 60 min$0 0%
- 99489 Extra 30 min$0 0%
PCM
- 99426 Staff 30 min$2,016 7%
- 99427 Staff extra 30 min$490 2%
- 99424 Physician 30 min$0 0%
- 99425 Physician extra 30 min$0 0%
Adjust 2026 CPT rates ($) and view billing rules
- 99453 is billed once per newly enrolled patient (setup and education).
- Device supply each month: 99454 (16+ days of data) or 99445 (2–15 days), one or the other.
- Management each month: 99457 (20+ minutes) or 99470 (10–19 minutes), not both; 99458 repeats for each extra 20 minutes.
- 99091 is a separate physician interpretation of physiologic data.
- CCM: 99490 + 99439 (clinical staff time) or 99491 (physician 30 minutes); 99487 + 99489 for complex CCM.
- PCM: 99426 + 99427 (clinical staff time) or 99424 + 99425 (physician time), for one complex condition.
- RPM may be billed alongside CCM or PCM for an eligible patient when the time is distinct. CCM and PCM can't be billed by the same practitioner for the same patient in the same month.
Estimates use editable, approximate national-average 2026 rates and your assumptions. Actual reimbursement varies by payer, locality, documentation and medical necessity. Educational only, not billing advice; verify against the current Medicare Physician Fee Schedule.
Sample Monthly Workflow
- 01
Flag Abnormal Measurements
The system immediately identifies values that cross your custom, specialty-defined thresholds.
- 02
Clinical Review Of Data
US-based clinical monitors analyze flags and escalate severe deviations to your clinicians.
- 03
Document Interventions
A clear audit trail is kept inside the platform for every outbound check-in and call.
- 04
Document Time & Generate Codes
Monitoring minutes are calculated automatically and the month's claims are prepared with the correct codes.
Connected Care Starts Here
See how e-Vitals helps your practice launch, run and document Medicare care programs with devices, onboarding, clinical dashboards and billing support in one platform.