CCM, PCM, APCM, RPM and RTM codes for 2026

Payment figures are the CY2026 national non-facility amounts, calculated from CMS’s own relative value file and the 2026 conversion factor of $33.40. Your locality will differ. The rules cite the CMS document they come from; the list is at the bottom.

What changed for 2026. The conversion factor rose to $33.40. Remote monitoring gained device-supply codes for 2 to 15 days of data (99445 for RPM, 98984 to 98986 for RTM) and 10-minute treatment-management codes (99470 for RPM, 98979 for RTM). Advanced primary care management gained three behavioral-health add-ons (G0568 to G0570). The rural health clinic and FQHC bundle code G0511 was retired at the end of September 2025; those clinics now bill the individual codes below.

Chronic care management (CCM)

For patients with two or more chronic conditions expected to last at least twelve months, at significant risk of death, acute exacerbation or functional decline. Billed once per calendar month by one practitioner. Clinical-staff codes are furnished under general supervision.

Non-complex and complex CCM cannot be billed in the same month, and the clinical-staff codes cannot be billed with the practitioner codes in the same month. Pick the pair that matches who did the work.

Rural health clinics and FQHCs. G0511, the general care-management bundle, was billable only through 30 September 2025 and is deleted for 2026. RHCs and FQHCs now bill the individual CCM, PCM, APCM, RPM, RTM and BHI codes at the national non-facility rates.

Principal care management (PCM)

For a single high-risk condition expected to last at least three months, managed under a disease-specific care plan. A new initiating visit is required after a year without one.

CCM and PCM cannot be billed by the same practitioner for the same patient in the same month. Two different practitioners managing different conditions under two care plans can each bill their own.

Advanced primary care management (APCM)

Effective 1 January 2025. Paid per patient per calendar month to the practitioner who is the continuing focal point for the patient’s primary care. There is no time threshold. Payment is tied to the practice having the capabilities and delivering the service, not to minutes. APCM bundles elements of CCM, PCM, TCM, interprofessional consultation, remote evaluation of images and video, virtual check-ins and e-visits.

What APCM requires. Documented consent. An initiating visit for new patients, unless the patient was seen within three years or received APCM, CCM or PCM within the last year. 24/7 access and continuity of care. Comprehensive care management with an electronic, patient-centred care plan. Care-transition management with follow-up within seven days of discharge. Enhanced communication channels. Population-level management. Performance measurement through the Value in Primary Care MVP or participation in an ACO, REACH, Making Care Primary or Primary Care First.

What it displaces. The same practitioner cannot bill CCM, PCM, TCM, interprofessional consultation, remote evaluation of patient images, virtual check-ins or e-visits for an APCM patient in the same month. A different practitioner can. BHI, collaborative care, community health integration, principal illness navigation, SDOH risk assessment, RPM and RTM can all be billed alongside APCM.

The 10-minute and 20-minute thresholds on 99484, 99492 and 99493 still apply when those codes are billed on their own, outside APCM.

Remote physiologic monitoring (RPM)

Physiologic data, such as blood pressure, weight, glucose or pulse oximetry, collected by an FDA-defined medical device and transmitted automatically. Requires an established patient relationship, consent, and one practitioner per patient per 30 days. RPM and RTM cannot both be billed for the same patient.

The 16-day rule in 2026. 99454 still requires 16 or more days of data. What changed is that 2 to 15 days is now billable under 99445, at the same national amount. CMS’s own RPM page now states the device must collect and transmit data at least 2 days in every 30. The data-day requirement does not apply to the treatment-management codes 99457 and 99458.

Remote therapeutic monitoring (RTM)

Non-physiologic data on therapy adherence or response: respiratory-device use such as PAP therapy, musculoskeletal activity, or cognitive behavioral therapy. Same structure as RPM, without the established-patient requirement.

For a sleep practice running PAP-adherence monitoring, the pair that carries the program is 98976 for the device month and 98980 for the twenty minutes of review, with 98984 now covering the patient whose device reported fewer than sixteen days.

Behavioral health integration and transitional care, briefly

TCM and CCM can be billed in the same month; TCM minutes cannot be counted toward CCM. BHI and CCM can be billed in the same month with consent for both.

The rules that apply across all of them

One practitioner per month. CCM, APCM, TCM, and RPM or RTM per 30-day period, are each billed by one practitioner for a given patient.

Time counts once. CCM and RPM, or CCM and RTM, can be billed in the same month for the same patient. The same minute cannot be counted toward both. The same rule applies to TCM, BHI and PCM time.

RPM or RTM, not both. And only one of them alongside CCM or TCM.

The device-day codes are either/or. 99445 replaces 99454 in a 30-day period with fewer than sixteen data days; it does not add to it. The same holds for 98984 to 98986 against 98976 to 98978. The 10-minute management codes replace, and do not add to, the 20-minute ones.

Consent, documented. Written or verbal, covering availability of the service, cost sharing, the one-practitioner rule and the right to stop. Obtained once, unless the practitioner changes.

A person’s minutes. Every time-based code above pays for clinical staff or practitioner time. Software that runs the outreach, collects readings or drafts the note is doing the program’s logistics; its activity is not billable time. Practices that separate the two, and log the human minutes as they are spent, are the ones whose claims hold up. See chronic care management software for how Caesar draws that line.

What cannot be billed together

A note on the 2026 figures

The November 2025 rule priced 99454, 98976 and 98977 on proposed hospital outpatient data. A correction notice on 12 March 2026, applicable from 1 January, re-priced them on final data, and every CMS RVU release since 29 December 2025 carries the corrected values shown here. CMS’s separate RHC and FQHC rate table, dated June 2026, still prints the earlier figures for those three codes. If a contract depends on them, confirm with your Medicare Administrative Contractor.

98978 and 98986 are contractor-priced and have no national amount. Facility amounts and the qualifying-APM conversion factor ($33.57) produce different figures from those shown.