Overview
The HealthArc Billing Engine automatically evaluates patient activity, documented care management time, device readings, and program eligibility against configured billing rules to determine when CPT codes become eligible for billing.
This article serves as a reference guide for all CPT/HCPCS codes currently supported in the HealthArc platform, including:
Supported care management programs
CPT/HCPCS code descriptions
Platform trigger logic
Billing type
Monthly execution limits
CMS billing considerations
Important
Platform eligibility indicates that billing requirements configured in HealthArc have been met. Providers remain responsible for ensuring all CMS documentation, supervision, consent, medical necessity, and payer-specific requirements are satisfied before submitting claims.
Remote Patient Monitoring (RPM)
CMS RPM services require the use of an FDA-defined medical device that automatically transmits physiologic data. Interactive communication requirements apply to treatment management codes (99457/99458).
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99453 | Initial device setup and patient education | First successful device reading after onboarding | Readings (1 reading) | Once per episode of care* |
99454 | Supply of device with daily recordings and programmed alerts | 16 transmitted readings during a 30-day period | Readings | 1 |
99457 | Initial RPM treatment management with interactive communication | Interactive Communication required + 20 minutes documented care time | Time | 1 |
99458 | Each additional 20 minutes of RPM treatment management | Interactive Communication required + 40 total documented minutes | Time | 1 |
Additional RPM CPT Codes (Effective 2026)
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99445 | Remote physiologic monitoring device supply with daily recordings or programmed alerts; 2–15 days of transmitted physiologic data during a 30-day period. | Triggered when the patient has 2–15 qualifying transmitted device readings within a rolling 30-day period. This code is mutually exclusive with CPT 99454. | Readings | 1 |
99470 | Remote physiologic monitoring treatment management services requiring at least one real-time interactive communication with the patient/caregiver and 10–19 minutes of clinical staff, physician, or qualified healthcare professional time during a calendar month. | Triggered when 10–19 minutes of qualifying RPM care management time has been documented and at least one interactive communication has been completed during the calendar month. This code is mutually exclusive with CPT 99457. | Time | 1 |
Platform Logic
Interactive Communication Required: Yes for 99457, 99458 & 99470
99453 – Eligible after the first successful device setup and qualifying transmission.
99445 – Eligible when 2–15 qualifying device transmissions are received within a 30-day period.
99454 – Eligible when 16 or more qualifying device transmissions are received within a 30-day period.
99470 – Eligible when 10–19 minutes of RPM treatment management time is documented and at least one interactive communication is completed.
99457 – Eligible when 20 or more minutes of RPM treatment management time is documented and at least one interactive communication is completed.
99458 – Eligible for each additional 20 minutes beyond the initial 20 minutes billed under 99457.
CMS Billing Considerations
99453 is generally billed once per device episode.
99454 cannot be billed without sufficient transmitted device data.
Time for 99457/99458 must include interactive communication with the patient or caregiver.
99445 and 99454 are mutually exclusive. Only one device supply code may be billed per patient during the same 30-day monitoring period based on the number of qualifying transmission days.
99470 and 99457 are mutually exclusive. If treatment management time is 10–19 minutes, bill 99470. If treatment management time reaches 20 minutes or more, bill 99457 instead.
Both 99470 and 99445 require at least one real-time interactive communication with the patient or caregiver during the calendar month.
These two CPT codes were introduced in the 2026 CMS Physician Fee Schedule to allow reimbursement for shorter RPM monitoring periods (2–15 days) and shorter treatment management time (10–19 minutes), which were previously not billable under the RPM code set.
Chronic Care Management (CCM)
CCM services support patients with multiple chronic conditions expected to last at least 12 months.
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99490 | Standard CCM (Clinical Staff) | 20 minutes | Time | 1 |
99439 | Each additional 20 minutes | 40 cumulative minutes | Time | 1 |
99491 | Physician/QHP personally performs CCM | 30 minutes | Time | 1 |
99487 | Complex CCM | Moderate/High Complexity + 60 minutes | Time | 1 |
99489 | Additional Complex CCM | Moderate/High Complexity + 90 cumulative minutes | Time | 1 |
99437 | Additional physician/QHP CCM time | 60 cumulative minutes | Time | 1 |
Platform Logic
Interactive Communication: Not required
Complexity must be identified where applicable
Billing becomes eligible once configured monthly time threshold is reached
Remote Therapeutic Monitoring (RTM)
RTM services monitor therapeutic adherence and response using FDA-defined medical devices.
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
98975 | Device setup and patient education | First transmitted reading | Readings | 1 |
98976 | Respiratory monitoring device supply | 16 readings | Readings | 1 |
98977 | Musculoskeletal monitoring device supply | 16 readings | Readings | 1 |
98978 | Cognitive Behavioral Therapy monitoring | 16 readings | Readings | 1 |
98980 | RTM treatment management | Interactive Communication + 20 minutes | Time | 1 |
98981 | Additional RTM treatment management | Interactive Communication + 40 cumulative minutes | Time | 1 |
98984 | Respiratory monitoring (short duration configuration) | 2–15 readings | Readings | 1 |
98985 | Musculoskeletal monitoring (short duration configuration) | 2–15 readings | Readings | 1 |
98986 | CBT monitoring (short duration configuration) | 2–15 readings | Readings | 1 |
98979 | Initial RTM treatment management | Interactive Communication + 10–20 minutes | Time | 1 |
Platform Logic
Device setup codes trigger after first qualifying reading.
Monitoring codes evaluate transmitted readings.
Treatment management codes require documented care time and interactive communication.
Principal Care Management (PCM)
PCM services support patients with one serious chronic condition requiring disease-specific management.
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99424 | Physician/QHP PCM | 30 minutes | Time | 1 |
99425 | Additional physician/QHP PCM | 60 cumulative minutes | Time | 1 |
99426 | Clinical staff PCM | 30 minutes | Time | 1 |
99427 | Additional clinical staff PCM | 60 cumulative minutes | Time | 1 |
Platform Logic
No interactive communication requirement
Time-based eligibility
Monthly execution limited to one occurrence per code
Transitional Care Management (TCM)
TCM services support patients transitioning from inpatient care to the community.
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99495 | Moderate complexity TCM | Completion of required transitional care workflow | Complexity | 1 |
99496 | High complexity TCM | Completion of required high-complexity workflow | Complexity | 1 |
Platform Logic
The platform evaluates completion of configured transitional care requirements and complexity level before making the code eligible.
Medication Therapy Management (MTM)
MTM services document pharmacist-led medication review and optimization.
CPT Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99605 | Initial MTM (new patient) | Interactive Communication + 15 minutes | Time | 1 |
99606 | Follow-up MTM (established patient) | Interactive Communication + 15 minutes | Time | 1 |
99607 | Each additional 15 minutes | Interactive Communication + 30 cumulative minutes | Time | 1 |
G2025 | Monthly MTM review (where applicable) | Monthly recurring review completed | Recurring | 1 |
Advanced Primary Care Management (APCM)
HCPCS APCM codes support longitudinal primary care management based on patient eligibility.
HCPCS Code | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
G0556 | APCM – Single qualifying chronic condition | One qualifying eligibility criterion | Eligibility | 1 |
G0557 | APCM – Multiple chronic conditions | Two qualifying eligibility criteria | Eligibility | 1 |
G0558 | APCM – Qualified Medicare Beneficiary (QMB) | Two qualifying eligibility requirements including QMB status | Eligibility | 2 |
Behavioral Health Integration (BHI)
Behavioral Health Integration supports ongoing behavioral health care coordination.
CPT/HCPCS | CMS Description | HealthArc Trigger Logic | Billing Type | Monthly Limit |
99484 | General Behavioral Health Integration | 20 documented care minutes | Time | 1 |
G0570 | Monthly behavioral health integration furnished by Clinical Psychologists/Clinical Social Workers | Monthly behavioral health workflow completed | Workflow | 1 |
Billing Trigger Types Used in HealthArc
Trigger Type | Description |
Time | Eligible once documented care management time reaches the configured threshold. |
Readings | Eligible once the required number of qualifying device transmissions is received. |
Interactive Communication (IC) | Requires documented real-time communication between the provider/clinical staff and the patient or caregiver, where required by CMS. |
Complexity | Eligibility depends on the documented level of medical decision-making or clinical complexity. |
Eligibility | Patient must satisfy configured CMS eligibility requirements for the program. |
Recurring | Monthly workflow completion is required before billing eligibility is established. |
General CMS Billing Considerations
Before submitting any claim, providers should verify that:
Appropriate patient consent has been obtained when required.
The patient meets CMS eligibility requirements for the applicable program.
Time documented is accurate, non-duplicative, and supported by clinical documentation.
Required interactive communication has been completed for applicable RPM and RTM treatment management codes.
Device-generated data meets CMS requirements where applicable.
Billing complies with current CMS guidance as well as payer-specific coverage policies.
HealthArc eligibility indicates platform rule validation only and does not replace provider billing judgment or CMS compliance requirements.