Reimbursement · CPT reference
RPM, CCM, and PCM billing codes
The practice bills remote patient monitoring, chronic care management, and principal care management. TOCA does not bill insurance. TOCA documents consent, device days, minutes, and the care plan so the CPT file matches the work. Dollar figures are approximate 2026 national Medicare amounts, not a guarantee.
Remote patient monitoring
Physiologic data from cellular devices — blood pressure, glucose, weight, and oxygen — reviewed against the thresholds you set. 2026 added a shorter device-supply code (99445) and a 10-minute management code (99470).
| CPT | What it covers | When you use it | ~2026 |
|---|---|---|---|
| 99453 | Initial set-up and patient education. | Once per episode, when the device is placed. | ~$22 |
| 99445 | Device supply, 2–15 days in 30 days. | Shorter months that do not reach 16 days. | ~$52 |
| 99454 | Device supply, 16 or more days. | The standard monthly device-supply code. | ~$52 |
| 99470 | First 10 minutes of RPM management. | Management time that does not reach 20 minutes. Not with 99457. | ~$26 |
| 99457 | First 20 minutes of RPM management. | Core monthly code once 20 minutes and a live interaction are documented. | ~$52 |
| 99458 | Each additional 20 minutes. | Add-on to 99457. Up to two units in the same month. | ~$41 |
Chronic care management
Two or more chronic conditions expected to last at least 12 months that place the patient at significant risk. A comprehensive care plan is established, revised, or monitored.
| CPT | What it covers | When you use it | ~2026 |
|---|---|---|---|
| 99490 | Standard CCM, first 20 minutes. | Clinical staff under physician direction. | ~$66 |
| 99439 | Each additional 20 minutes. | Add-on to 99490. Up to two units in the same month. | ~$50 |
| 99487 | Complex CCM, first 60 minutes. | Moderate or high complexity decision making. | ~$144 |
| 99489 | Each additional 30 minutes of complex CCM. | Add-on to 99487. | ~$78 |
| 99491 | Physician CCM, first 30 minutes. | Not billed with staff CCM the same month. | See PFS |
| 99437 | Each additional 30 minutes of physician CCM. | Add-on to 99491 only. | See PFS |
Principal care management
One high-risk chronic condition expected to last at least 3 months. Often the right fit when a specialist owns CKD, heart failure, or resistant hypertension.
| CPT | What it covers | When you use it | ~2026 |
|---|---|---|---|
| 99424 | PCM, physician time, first 30 minutes. | Single high-risk disease the physician owns. | See PFS |
| 99425 | Each additional 30 minutes of physician PCM. | Add-on to 99424. | See PFS |
| 99426 | PCM, clinical staff, first 30 minutes. | Staff time under physician direction. | See PFS |
| 99427 | Each additional 30 minutes of staff PCM. | Add-on to 99426. | See PFS |
Panel estimate
What a panel can return.
Put in your patients and the share of RPM, CCM, or PCM codes you expect to bill. The estimate subtracts TOCA’s $75 fee per patient per month.
Programs
CCM and PCM are not billed for the same patient in the same month. RPM can sit alongside either one when the work is distinct.
Share of the panel
Defaults match TOCA’s planning model. Move a code if your mix is different.
RPM
- 99453 · Setup and education, once per patient100%
$20 allowed · counted once, not every month
- 99454 · Device supply, 16 or more days90%
$55 allowed
- 99457 · First 20 minutes of RPM management80%
$53 allowed
- 99458 · Additional 20 minutes60%
$46 allowed
- 99458 ×2 · Second additional 20 minutes30%
$46 allowed
Answered directly.
Does TOCA bill Medicare?
No. The practice submits the claim. TOCA produces the documentation — consent, device days, time, and the care plan — that the biller uses.
Can RPM be billed with CCM or PCM?
Yes, when the work is distinct. Do not count the same minute twice, and do not bill CCM and PCM for the same patient in the same month.
Are the dollar amounts guaranteed?
No. Figures are approximate 2026 national Medicare physician fee schedule amounts. Locality, payer, and medical necessity change what is paid. CPT is a registered trademark of the American Medical Association.