mccoyheather

Networker
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28
Location
Rockledge, FL
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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!
 
Messages
451
Best answers
1
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.
 
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