Current Procedural Terminology (CPT) codes are a standardized system of medical billing codes maintained by the American Medical Association (AMA). Providers use CPT codes to describe and report medical services performed on patients. When a provider submits a claim to Medicare or another payer, the CPT code tells the payer what service was provided, and the payer determines reimbursement based on the associated relative value units and conversion factor.
CPT codes are considered "Level I" of the Healthcare Common Procedure Coding System (HCPCS). Level II HCPCS codes, which begin with a letter followed by four digits (such as G0556), are established by CMS to describe services and supplies not covered by CPT codes. In connected care, both CPT and HCPCS codes are used. CCM, RPM, PCM, and BHI use CPT codes (beginning with numbers, such as 99490). APCM uses HCPCS G-codes (G0556, G0557, G0558).
Time-Based vs. Service-Based Codes:
Most connected care codes are time-based, meaning reimbursement depends on how many minutes of service were provided in a calendar month. CCM and RPM require documented time to meet billing thresholds. APCM is an exception: it uses a service-availability model rather than time-based thresholds.
Code Selection and Compliance:
Selecting the correct code is essential for compliance and appropriate reimbursement. Billing the wrong code, double-counting time across programs, or failing to document the required elements can result in claim denials, overpayment recoveries, or audit liability. CMS publishes guidance in the annual PFS final rule, and the AMA provides periodic CPT Assistant articles interpreting code use.
Sources:
AMA CPT Code Manual;
CMS HCPCS coding system overview; 42 C.F.R. Part 414.
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