RPM Code for 10–20 Minutes of Care Management Time: Guide to CPT 99XX5

Stay current with Medicare's most recent changes and register for our webinar "Understanding Medicare's 2026 Changes to Remote Care Management," on November 20, 2025, at 2:00 PM ET / 11:00 AM PT. Medicare expert, Daniel Tashnek, J.D., will discuss the new RPM CPT codes and other impactful updates in the PFS final rule.

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Remote patient monitoring (RPM) continues to evolve as the Centers for Medicare & Medicaid Services (CMS) works to make care management programs more flexible and accessible. One of the most notable additions in the Medicare 2026 Physician Fee Schedule (PFS) proposed rule is CPT 99XX5, a new RPM treatment management code designed for 10–20 minutes of care management time per calendar month.

Under the current RPM coding rules, providers can only bill CPT 99457 once they meet the 20-minute threshold in a given month. This creates a gap in reimbursement when clinically meaningful work is performed but falls short of 20 minutes. CPT 99XX5 is intended to fill this gap — ensuring providers can be paid for shorter, yet still valuable, care management work and patient interactions.

In this post, we break down everything you need to know about the proposed CPT 99XX5, including valuation details, billing requirements, how it fits with other RPM and care management codes, and best practices for implementation.

The History Behind RPM CPT 99XX5

Providers and industry stakeholders have long advocated for more flexible RPM time thresholds. The 20-minute minimum for CPT 99457 often meant that brief, but important, clinical touchpoints went unreimbursed.

In late 2024, the American Medical Association’s CPT Editorial Panel approved the new time-based management code — 99XX5 — to address this gap. CMS’s 2026 PFS proposal adopts this code but values it at roughly half the reimbursement rate of 99457, lower than AMA’s recommended rate.

While the valuation is more conservative than many hoped, the code’s proposed addition is still a significant policy step forward, recognizing that shorter interactions can carry meaningful clinical value.

Improving Clinical Flexibility With the 10–20 Minute RPM CPT Code

If approved, CPT 99XX5 will give providers more flexibility to deliver and bill for care management that does not meet the 20-minute threshold. This benefits providers by ensuring they are compensated for valuable care that would otherwise go uncompensated, and it benefits patients by encouraging providers to offer support to more individuals who could benefit from timely care management.

Common use cases include:

• Post-medication adjustment follow-up: Reviewing a small number of transmitted readings and making medication changes.
• Targeted symptom check-ins: Addressing new symptoms or confirming stability without a full 20-minute review.
• Intermittent monitoring patients: Individuals who require periodic oversight rather than continuous, intensive engagement.

By enabling payment for these scenarios, CPT 99XX5 better aligns reimbursement with clinical workflows and patient needs.

Key Details About CPT 99XX5

To see how CPT 99XX5 could work in practice, it helps to review the core components outlined in the 2026 PFS Proposed Rule. From billing frequency to transmission requirements, these details define when and how the new RPM code may be used.

• Code name (proposed): CPT 99XX5
• Status: Included in CMS's 2026 PFS proposed rule
• Description: RPM treatment management services provided by clinical staff, physician, or other qualified healthcare professional for 10–20 minutes in a calendar month, requiring at least one interactive communication with the patient or caregiver.
• Billing frequency: Once per calendar month per patient
• Thresholds: Covers exactly 10–20 minutes; for ≥20 minutes, bill CPT 99457 instead
• Reimbursement: Estimated at roughly half the rate of CPT 99457
• Mutually exclusive: Cannot bill 99XX5 and 99457 for the same patient in the same month

Who Can Bill for CPT 99XX5?

Similar to other RPM codes, CPT 99XX5 must be billed by a provider with a national provider identifier (NPI) number. However, internal clinical staff or external clinical staff can administer most of the program under general supervision, saving physician time and involvement. Eligible providers include: 

• Physicians
• Advanced practice registered nurses (APRNs)
• Physician assistants (PAs)
• Clinical staff operating under general supervision

Only one provider may bill 99XX5 per patient per calendar month.

Billing Requirements for CPT 99XX5

To receive reimbursement under CPT 99XX5, the following conditions must be met:

1. Time threshold: Total RPM management time in the month must be at least 10 minutes but fewer than 20 minutes.
2. Interactive communication: Must include at least one real-time, interactive communication with the patient or caregiver.
3. Documentation: Must document cumulative time spent and describe the clinical work performed.
4. Non-overlapping services: Time counted for 99XX5 cannot be counted toward other time-based codes such as CCM or E/M services.
5. Once per month: Only one unit of 99XX5 may be billed per patient per month.

FAQs About CPT 99XX5

Now let’s answer three common questions asked about this new proposed code.

1. Can CPT 99XX5 Be Billed Concurrently With CPT 99457?

No, you can bill either 99XX5 or 99457 in a given month, depending on the total time.

• More than 10 and no more than 20 minutes = bill 99XX5
• 20 minutes or more = bill 99457 (and 99458 if applicable)

2. Can CPT 99XX5 Be Billed Concurrently With CPT 99458?

Yes, providers can bill 99XX5 for the initial 10-20 minutes, then add 99458 for additional 20 minute increments.

3. Can 99XX5 Be Billed More Than Once A Month?

No, CPT 99XX5 can only be billed one time per calendar month.

How CPT 99XX5 Fits in With Other RPM Codes

Here’s how CPT 99XX5 fits into the broader RPM billing structure:

*Estimated reimbursement values as of August 2025

Compared to 2025, this additional code — along with the proposed 99XX4 covering 2-15 days of monthly RPM device supply and data transmission — will significantly expand revenue opportunities for providers. Take one of Prevounce’s clients for example. A 522-patient RPM program out of upstate New York is focused on longitudinal hypertension and diabetes monitoring. In June 2025, 16% of patients (83 total) had between 2 and 16 measurements and 6% of patients (31 total) received between 10 and 20 minutes of care management time. Here’s a side by side comparison of 2025 revenue compared to 2026 forecasted revenue (assuming no new patients are added):

This program would see a 13% increase in revenue — nearly $65,000 — thanks to the new reimbursement opportunities.

Best Practices for Billing the 10–20 Minute RPM CPT Code

To make the most of CPT 99XX5 while staying compliant, follow these recommendations:

• Track time precisely within your RPM platform
• Differentiate services clearly from CCM, PCM, or E/M
• Educate staff on when to use 99XX5 vs. 99457
• Document clinical value of even short interactions
• Keep logs and summaries of communications and data reviews

Final Thoughts on the Proposed 10–20 Minute RPM CPT Code

CPT 99XX5 would be a welcome addition to RPM coding, allowing providers to capture reimbursement for meaningful but shorter management interactions. This CPT code would create new opportunities to align billing with real-world care delivery patterns.

With accurate time tracking and clear documentation, practices will be able to seamlessly integrate this code into their workflows to enhance both patient care and revenue.

Get More Out of RPM With Prevounce

Whether you’re preparing to bill 99XX5 in 2026 or looking to optimize your current RPM program, Prevounce can help you appropriately leverage the latest codes for maximum clinical and financial benefit. Schedule a demo with our care management experts to learn more.

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Disclaimer

Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.

Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.