Wiki 99458 RPM / 99439 CCM

[mccoyheather]

CCM - Chronic Care Management threshold time is met at 15 minutes for the first 20 minutes. When "each additional" 20 minutes is met 99439 what is the minimum threshold? Provider(s) are stating is the same 15 minute rule is applicable, is this correct?
RPM - Remote Patient Monitoring threshold time 99457/99458 - 99457 20 Minute minimum applies. What is time threshold for "each additional time" 20 minutes 99458? Example, total RPM time is 37 min and 15 seconds, (three minutes short of the additional 20 min) I cannot find any guidelines for threshold times and RPM! Provider is recommending billing dept follow the 15 min rule for CCM (due to chronic disease process monitoring services). All responses and or guidelines welcomed with much thanks!

 

[mccoyheather]

Thank you for your response, I will forward time based codes guidelines to the providers (again).

 

[Mrsrpc]

So is this to say no additional time may be reported unless it is a 20 minute block?

 

[eilujs1999]

Hi there,

Please see the CPT manual guidelines for these code sets for details, but to summarize:

CCM - When the service is performed by clinical staff they must perform at least 20 minutes. When the service is performed by the physician/QHP they must perform at least 30 minutes. It might help to share the time chart in the manual with your providers.

RPM - The provider must perform at least 20 minutes for both codes.

Hello,
For RPM, I see that you said that the provider must perform at least 20 minutes for both codes. How would I code if the provider performs an additional 20 minutes? So 20 minutes for 99457, 20 minutes for 99458 but how would I code an additional 20 minutes?

 

[MonicaS17]

Hello,
For RPM, I see that you said that the provider must perform at least 20 minutes for both codes. How would I code if the provider performs an additional 20 minutes? So 20 minutes for 99457, 20 minutes for 99458 but how would I code an additional 20 minutes?

RPM Communication - 20 - 39 minutes = 99457; 40 to 59 minutes = 99457 and 99458; 60 to 79 minutes = 99457 and 99458 x 2 (with 2 units); 80 to 99 minutes = 99457 and 99458 x 3 (with 3 units). Anything more than 99 minutes you will not be reimbursed for because it has a MUE of 3.

 

[jkyles]

CCM - Chronic Care Management threshold time is met at 15 minutes for the first 20 minutes. When "each additional" 20 minutes is met 99439 what is the minimum threshold? Provider(s) are stating is the same 15 minute rule is applicable, is this correct?
RPM - Remote Patient Monitoring threshold time 99457/99458 - 99457 20 Minute minimum applies. What is time threshold for "each additional time" 20 minutes 99458? Example, total RPM time is 37 min and 15 seconds, (three minutes short of the additional 20 min) I cannot find any guidelines for threshold times and RPM! Provider is recommending billing dept follow the 15 min rule for CCM (due to chronic disease process monitoring services). All responses and or guidelines welcomed with much thanks!

Hi there,

Please see the CPT manual guidelines for these code sets for details, but to summarize:

CCM - When the service is performed by clinical staff they must perform at least 20 minutes. When the service is performed by the physician/QHP they must perform at least 30 minutes. It might help to share the time chart in the manual with your providers.

RPM - The provider must perform at least 20 minutes for both codes.