The world of remote patient monitoring (RPM) is becoming more flexible and aligned with real-world clinical practice, due to key updates from the Centers for Medicare & Medicaid Services (CMS) for Calendar Year (CY) 2026. A part of this evolution is the introduction of CPT code 99470 and CPT Code 99445. For care services teams, new CPT code 99470 is a vital addition, ensuring they can be properly reimbursed for the valuable, shorter care management interactions that were often previously uncompensated.
What is CPT Code 99470?
CPT code 99470 is the new code specifically designed to capture the treatment management time provided by clinical staff, physicians, or other qualified health care professionals when the total time spent in a calendar month is less than the 20-minute threshold required by the existing CPT code 99457.
Here is the essential breakdown of CPT code 99470:
- Service Covered: Remote physiologic monitoring treatment management services. This includes reviewing data, communicating with the patient/caregiver, and making clinical decisions.
- Time Requirement: The code covers the first 10–19 minutes of cumulative time spent in a calendar month.
- Mandatory Component: It requires at least one real-time, interactive communication with the patient or caregiver during the calendar month.
- Billing Frequency: CPT code 99470 can be billed once per calendar month per patient.
This code effectively fills the gap created by the 20-minute minimum for CPT 99457, acknowledging that short, targeted clinical touchpoints are essential for effective chronic care management.
The Clinical and Financial Value
The ability to bill for shorter time increments directly improves your program’s efficiency and patient care quality. Many critical RPM services don’t require a full 20 minutes of staff time.
CPT code 99470 allows you to capture reimbursement for:
- Quick Follow-ups: A 10-minute synchronous call with a patient whose blood pressure readings briefly spiked, confirming compliance or adjusting a minor dosage.
- Targeted Symptom Checks: A quick, interactive check-in to confirm a patient’s stability after a new medication was initiated, falling short of the 20-minute mark.
- Post-Data Review Messaging: Time spent reviewing transmitted data and then engaging in a brief, live interactive communication to discuss findings.
Clinical staff can now focus on providing high-quality, targeted care without the pressure of needing to meet a minimum 20-minute threshold for every patient interaction. This flexibility can lead to:
- Reduced Burnout: More manageable patient engagement requirements.
- Increased Capacity: Staff can efficiently manage a larger patient panel by quickly addressing low-acuity alerts and stable patients.
Billing and Compliance Rules for CPT Code 99470
Proper billing under the new rules requires meticulous time tracking and adherence to specific guidelines:
| CPT Code | Service Description | Time Requirement (in a Calendar Month) | Interactive Communication | Billing Rule |
| 99470 (NEW) | RPM Management Services | 10–19 minutes | Required (at least one real-time interaction) | Mutual Exclusive with 99457/99458 |
| 99457 (Existing) | RPM Management Services | First ≥ 20 minutes | Required (at least one real-time interaction) | Cannot be billed with 99470 |
| 99458 (Existing) | RPM Management Services | Each additional 20 minutes | N/A (follows 99457) | Billed add-on to 99457 only |
Compliance Checklist
- Mutual Exclusivity: You must choose either CPT code 99470 (10-19 min) or CPT code 99457 ( ≥ 20min) in a given calendar month, but not both.
- Interactive Communication: A non-negotiable requirement. The communication must be real-time and synchronous (e.g., phone call, video chat). Secure messaging, voicemails, or asynchronous texts alone do not qualify for meeting this core requirement.
- Documentation: Your RPM platform and EHR must clearly document the following for CPT code 99470
- The cumulative minutes of clinical staff time spent (must be ≥ 10 minutes and ≥ 20 minutes).
- The date, time, and method of the required real-time interactive communication.
- The clinical necessity and summary of the services provided.
4. Non-Duplication: Time billed under CPT code 99470 cannot be counted toward other time-based codes like Chronic Care Management (CCM) or other Evaluation and Management (E/M) services.
Support for CPT Code 99470 Compliance
At Tenovi, our devices and data aggregation simplify the complex regulatory requirements of codes like CPT code 99470. The adoption of CPT code 99470 is a definitive step toward making RPM sustainable and profitable across a wider array of clinical scenarios. It rewards efficiency and recognizes the value of brief, timely clinical interventions. Are you leveraging the flexibility of CPT code 99470 to maximize your RPM reimbursement? Contact Tenovi today.
