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99445 and 99470 drop the adherence floor to 2 transmission days.
Titra Health

Programs & codes

Three programs. Different gates.

RPM pays for a device and the time spent on what it sends. CCM pays for coordinating complex patients whether or not a device exists. They stack on the same patient, and each one fails for its own reason — so the platform tracks each one’s requirements separately.

RPM

Remote Patient Monitoring

A cellular scale ships to the patient’s home. They step on it. Readings arrive on their own — no app, no Wi-Fi, no pairing — and your team monitors the trend between visits.

What it requires

  • A practitioner order for the monitoring device
  • Consent recorded before anything ships
  • Device-transmitted readings only — never patient-reported
  • At least one live two-way conversation per month to bill management

Codes

99453Device set-up & patient educationOnce per episode, needs ≥2 transmission days$21.71
99454Device supply, 16–30 daysRequires 16 transmission days in the 30-day period$52.10
99445Device supply, 2–15 daysNew for 2026. One device code per period — never alongside 99454$52.10
99457Treatment management, first 20 minRequires one real-time interactive communication in the month$51.77
99458Each additional 20 minAdd-on to 99457 only. Never stacks onto 99470$41.41
99470Treatment management, first 10 minNew for 2026. An alternative to 99457 at 10–19 min, not an addition$26.05

Illustrative CY2026 national non-facility Medicare averages, shown to size the program. Your allowed amounts come from your own fee schedule and your payer.

CCM

Chronic Care Management

For patients with two or more chronic conditions: a written care plan, 20 minutes of coordination a month, and 24/7 access to the care team. No device required.

What it requires

  • Two or more chronic conditions on the problem list
  • A comprehensive care plan on file before a month bills
  • Its own consent, taken separately from RPM
  • 20 minutes of clinical staff time, attributed and documented

Codes

99490First 20 min, clinical staffCalendar-month bucket, one practitioner per month$66.13
99439Each additional 20 min, clinical staffAdd-on to 99490$50.44
99491First 30 min, physician / QHPTime furnished personally. Cannot include clinical staff minutes$89.18
99437Each additional 30 min, physician / QHPAdd-on to 99491$63.13
99487Complex CCM, first 60 minModerate-to-high complexity decision making. Excludes 99490 that month$144.29
99489Complex CCM, each additional 30 minAdd-on to 99487$78.16

Illustrative CY2026 national non-facility Medicare averages, shown to size the program. Your allowed amounts come from your own fee schedule and your payer.

APCMBuilt, shipped dark

Advanced Primary Care Management

The 2025 G-code ladder that pays monthly on a capability attestation rather than a minute count. Built and tested in the platform, switched off until launch clinics are live on RPM and CCM.

What it requires

  • A practice-wide capability attestation
  • Patient assignment to a designated care team
  • Level determined by condition count and QMB status
  • No CCM, PCM or TCM for that patient the same month — APCM already covers it

Codes

G0556APCM level 10–1 chronic conditions$16.37
G0557APCM level 22+ chronic conditions$53.78
G0558APCM level 32+ conditions, QMB$117.24

Illustrative CY2026 national non-facility Medicare averages, shown to size the program. Your allowed amounts come from your own fee schedule and your payer.

The 2026 change that matters

The adherence floor dropped from 16 days to 2.

Until 2026, a 30-day device-supply period that landed under 16 transmission days was worth nothing. A patient who weighed in nine times — a real clinical signal, real staff work — produced no billable device code at all.

99445 now covers device supply at 2 to 15 transmission days, and 99470 covers management at 10 to 19 minutes. Partial months became billable months.

Titra Health’s engine picks the code the days and minutes actually support — 99454 at 16 days or more, 99445 below it, nothing at 0 or 1 — rather than reaching for the code that pays best. That distinction is the whole difference between a clean claim and a clawback.

Code reference.

CodeProgramWhat it pays forEst.
99453RPMDevice set-up & patient educationOnce per episode, needs ≥2 transmission days$21.71
99454RPMDevice supply, 16–30 daysRequires 16 transmission days in the 30-day period$52.10
99445RPMDevice supply, 2–15 daysNew for 2026. One device code per period — never alongside 99454$52.10
99457RPMTreatment management, first 20 minRequires one real-time interactive communication in the month$51.77
99458RPMEach additional 20 minAdd-on to 99457 only. Never stacks onto 99470$41.41
99470RPMTreatment management, first 10 minNew for 2026. An alternative to 99457 at 10–19 min, not an addition$26.05
99490CCMFirst 20 min, clinical staffCalendar-month bucket, one practitioner per month$66.13
99439CCMEach additional 20 min, clinical staffAdd-on to 99490$50.44
99491CCMFirst 30 min, physician / QHPTime furnished personally. Cannot include clinical staff minutes$89.18
99437CCMEach additional 30 min, physician / QHPAdd-on to 99491$63.13
99487CCMComplex CCM, first 60 minModerate-to-high complexity decision making. Excludes 99490 that month$144.29
99489CCMComplex CCM, each additional 30 minAdd-on to 99487$78.16
G0556APCMoffAPCM level 10–1 chronic conditions$16.37
G0557APCMoffAPCM level 22+ chronic conditions$53.78
G0558APCMoffAPCM level 32+ conditions, QMB$117.24

Estimates only, for sizing a program. RPM and CCM management time cannot be double-counted — the same minute belongs to one program, and only one practitioner may bill remote monitoring for a patient in a given calendar month. Medicare cost-sharing applies to the patient, which is part of what consent has to disclose.

Size it

Model a month against your own panel.

Every combination below is one the rules actually permit. Care management is a single choice rather than a set of checkboxes, because APCM and CCM cannot both be billed for the same patient in the same month — and a calculator that let you add them together would be quietly lying to you.

5500

Remote Patient Monitoring

A cellular device plus the time spent on what it sends.

Transmission days

Distinct days the device sent a reading, per 30-day period.

Management minutes

Staff time in the calendar month, with one live call.

Care management

Pick one. APCM and CCM cannot both be billed for the same patient in the same month, and neither can two CCM families — so this is a choice, not a set of checkboxes.

Additional 20-minute blocks99439

Estimated monthly program revenue

$6,800

$170.00 per enrolled patient, per month

  • 99454Device supply, 16–30 days$52.10
  • 99457Treatment management, first 20 min$51.77
  • 99490CCM, first 20 min (clinical staff)$66.13
Annualised
$81,600
Month one incl. set-up
$7,668

99453Device set-up & patient education — once per episode$21.71

An estimate, not a quote. Figures are CY2026 Medicare national non-facility averages. Your allowed amounts depend on your own fee schedule, your geographic locality adjustment and the payer at claim time, and Medicare cost-sharing applies to the patient. Staff time and Titra Health’s flat per-patient fee come out of this figure. Nothing here is coding or reimbursement advice.

Pairing rules

What stacks, and what does not.

Not allowed: APCM + CCM in the same month

Mutually exclusive for the same patient. APCM’s monthly payment already accounts for the care-management service, so billing both is a duplicate. This calculator models care management as one choice for exactly that reason.

Allowed: APCM + RPM in the same month

Allowed. A patient can be in APCM and remote monitoring at once — the device supply and its management time are a distinct service.

Allowed: CCM + RPM in the same month

Allowed, provided the time and documentation are discrete. The same minute may never count toward both, which is why every time log names the program it belongs to.

Not allowed: 99470 + 99457 in the same month

Alternatives, not a ladder. Under 10 minutes earns nothing, 10–19 minutes is 99470, and once the month reaches 20 minutes the correct code is 99457 — not 99470 plus an add-on.

Not allowed: 99458 stacked onto 99470

99458 is an add-on to 99457 only. It never attaches to the 10-minute code.

Not allowed: 99454 + 99445 for one period

One device-supply code per 30-day period. The transmission-day count decides which: 16 or more earns 99454, 2 to 15 earns 99445, and 0 or 1 earns neither.

Not allowed: Complex CCM + standard CCM

99487/99489 and 99490/99439 are separate families for the same calendar month. Acuity and documented decision making pick one.

Not allowed: Two practitioners billing RPM for one patient

Only one practitioner may furnish and bill remote monitoring for a patient in a given calendar month — which is why enrolment asks whether anyone else already is.

Questions

Before you commit staff to this.

Ask us anything at team@titrahealth.io

You do, under your own NPI. Titra Health is software: it supplies the devices, the monitoring surface, the documentation, and a billing packet your biller works from. The fee is flat and monthly per enrolled patient, owed regardless of what you collect — never a share of collections.

Which of your patients actually qualify?

Bring your diagnoses and payer mix. We will walk the eligibility logic with you and tell you honestly if the answer is “not many”.

Book a walkthroughteam@titrahealth.io