2025 Billing Guide for Remote Care Services – RPM, CCM and APCM

CMS recently released the 2025 Physician Fee Schedule, introducing significant updates for Remote Care services. The new fee schedule includes the introduction of Advanced Primary Care Management (APCM) codes and the replacement of G0511 with standard CPT codes for Federally Qualified Health Centers (FQHCs) and Rural Health Center (RHCs). These changes aim to streamline billing and better align FQHC and RHC billing practices with other healthcare providers.

This guide covers 2025 national average reimbursement rates for Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and APCM. While reimbursement rates vary depending on your Medicare Administrative Contractor (MAC) and geographic location, this resource provides a comprehensive overview to help you optimize billing practices. For exact details, refer to the Physician Fee Schedule search tool.

Remote Patient Monitoring Codes and Reimbursement

CPT Code: 99453 – RPM Initial Setup

• Description: Covers the initial setup of RPM equipment and patient education
• Reimbursement: Approximately $20 per patient, one-time fee

CPT Code: 99454 – RPM Device Supply and Data Collection

• Description: Covers the supply of devices and collection of patient data over 30 days
• Reimbursement: Roughly $55 per patient, per month

CPT Code: 99457 – RPM First 20 Minutes of Monitoring

• Description: Covers the first 20 minutes of clinical staff time spent monitoring and managing patient data
• Reimbursement: Average $50 per patient, per month

CPT Code: 99458 – RPM Additional 20 Minutes

• Description: Covers each additional 20-minute increment of clinical staff time for RPM services
• Reimbursement: Approximately $40 per increment

Key Updates for 2025

• FQHCs and RHCs will now use the CPT codes above, rather than the G0511 code previously used.
• Who can provide RPM: Qualified Healthcare Professionals or auxiliary personnel under the general supervision of the billing provider. This allows practices to augment their clinical staff with outsourced clinical monitoring teams.

Non-Complex CCM Billing Codes and Reimbursement

CPT Code: 99490 – First 20 Minutes

• Description: First 20 minutes of clinical staff time spent providing non-complex CCM services to patients with 2+ chronic conditions
• Reimbursement: Average $62 per patient, per month

CPT Code: 99439 – Additional 20 Minutes

• Description: Each additional 20 minutes of non-complex CCM services (beyond the initial 99490)
• Reimbursement: Approximately, $48 per 20-minute increment, per month

Complex CCM Billing Codes and Reimbursement

CPT Code: 99491 – First 30 Minutes by Physician

• Description: 30 minutes of complex CCM provided by the physician
• Reimbursement: Average $83 per patient, per month

CPT Code: 99437 – Additional 30 Minutes by Physician

• Description: Add-on code for CPT code 99491; each additional 30 minutes by a physician or other qualified health care professional
• Reimbursement: Approximately, $59 per patient, per month

CPT Code: 99487 – First 60 Minutes of Complex CCM

• Description: Complex CCM, first 60 minutes of clinical staff time directed by a physician or other qualified health care professional
• Reimbursement: Average $132 per patient, per month

CPT Code: 99489 – Additional 30 Minutes of Complex CCM

• Description: Add-on code for CPT code 99487; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional
• Reimbursement: Roughly $71 per patient, per month

Key Update for 2025

• FQHCs and RHCs will now use the CPT codes above, rather than the G0511 code previously used.
• Who can provide CCM: Non-complex CCM can be provided by a Qualified Healthcare Professional or auxiliary personnel under the general supervision of the billing provider. This allows practices to augment their clinical staff with outsourced clinical monitoring teams.

Note: RPM and CCM services can be billed concurrently, providing an opportunity to maximize reimbursement rates.

NEW Advanced Primary Care Management Codes and Reimbursement

In 2025, CMS introduced new Advanced Primary Care Management codes to streamline billing by combining elements of Chronic Care Management (CCM), Principal Care Management (PCM), and Communications Technology-Based Services.

This approach reduces the administrative burden of time-based requirements and emphasizes meaningful interactions—whether in person, at home, or via telehealth. These new APCM codes reflect different levels of care complexity and reimbursement.

CPT Code: G0556 – APCM for One or More Chronic Conditions

• Description: APCM for patients with up to one or more chronic conditions
• Reimbursement: $15

CPT Code: G0557 – APCM for Multiple Chronic Conditions

• Description: APCM for patients with multiple chronic conditions
• Reimbursement: $50

Code: G0558 – APMC for Qualified Medical Beneficiaries

• Description: APCM for patients who are Qualified Medicare Beneficiaries (QMB) and have multiple chronic conditions.
• Reimbursement: $110

Key Notes

• APCM cannot be billed concurrently with CCM, but it can be billed concurrently with RPM.
• Practices offering APCM services should ensure staff are well–versed in combining care delivery models for optimized reimbursement.

Optimize Your Remote Care Billing in 2025

If your organization provides or is considering delivering remote care management services, understanding these updates is essential to maximizing your revenue potential. For more information about implementing RPM, CCM, or APCM services, or to learn how to streamline your billing process, contact us today!