Remote Care Cheat Sheet: 2026 CPT Billing Codes for RPM, CCM, APCM, PCM, TCM, RTM, AWV

Welcome to the 2026 edition of Lara Health’s annual Remote Care CPT Billing Codes Cheat Sheet, our second yearly release for clinicians, administrators, and revenue cycle leaders who want one authoritative reference that connects billing codes to real clinical operations. The CY 2026 CMS Physician Fee Schedule (PFS) continues the shift toward measurable, between-visit care, and it introduces refinements that make mature programs easier to run: more flexible remote monitoring structures, clearer thresholds for short-but-meaningful management months, and new pathways to operationalize behavioral health integration alongside primary care management. The purpose of this guide is simple: to help practices translate policy into workflow, so preventive care, chronic care, and remote monitoring are delivered consistently, documented cleanly, and reimbursed predictably.

In day-to-day practice, that translation challenge shows up as two parallel clinics. There’s the "visible clinic", with the appointment schedule, procedures, and face-to-face visits; then there’s the "invisible clinic" with team members triaging home readings, coordinating post-discharge care plans, closing care gaps, and addressing behavioral barriers that determine whether medical plans actually work. This cheat sheet is built for that invisible clinic, because it is where outcomes are increasingly won, and where reimbursement depends on operational discipline rather than good intentions alone.

One of the good news this year is that, as CMS continues to push outpatient care toward a model where between-visit operations are expected, measurable, and reimbursable, in 2026 that "invisible clinic" is no longer extra, unbillable work. The catch is that reimbursement is only as reliable as your workflow: consent captured, time and activities attributed cleanly, interactive touchpoints documented when required, and month-end close processes that make gaps visible while you can still fix them.

This guide is a one-stop, practice-ready cheat sheet for the core remote and preventive care code families that most outpatient teams use to build sustainable longitudinal care: Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Principal Care Management (PCM), Advanced Primary Care Management (APCM), Transitional Care Management (TCM), Remote Therapeutic Monitoring (RTM), and Annual Wellness Visits (AWVs). It’s written for clinicians, practice administrators, and billing teams who want a clear reference that connects codes to real operations, rather than a code list that only makes sense in a revenue cycle meeting.

Whether you are:

1. An experienced operator that just likes to have a detailed reference guide where all remote care billing codes are in one place.
2. New to remote care and need a clear, confident starting point for implementing reimbursable virtual services; or,
3. Running a DIY operation and want to ensure they’re not leaving money on the table through missed codes, incomplete documentation, or improper time capture;

This guide was created to make a simple and definitive reference cheat sheet for you.

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How to use this cheat sheet in 2026

Three quick notes will keep you out of trouble and save you hours of rework.

First, Medicare payment depends on setting. Many services have a non-facility (office) amount and a facility amount (for example, hospital outpatient department), and your national “ballpark” number changes accordingly. In this cheat sheet, the “rate” column is the approximate national non-facility Medicare payment using the CY 2026 conversion factor for non–Qualifying APM participants. Your locality, your MAC policies, your billing entity type, and whether the clinician is a Qualifying APM Participant (QP) will move the final number.

Second, use the rates the way an operator uses them: for program modeling and prioritization, not as guarantees. If you want exact payment in your zip code, look it up using the CMS Physician Fee Schedule look-up tool and confirm your site of service and modifiers.

Third, the biggest compliance failure is still the most mundane: double-counting time across programs or assuming that “we usually do it” is the same as “we can prove it.” A good 2026 remote care program is a documentation-and-workflow machine that happens to generate claims, not a claims machine that asks clinicians to retroactively justify work.

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What changed in 2026 that affects remote care operations

The biggest 2026 improvements are not philosophical; they are mechanical. CMS has made remote care programs more tolerant of the way real care works.

RPM now has a more usable “low-intensity month” pathway. New RPM device supply and shorter time-threshold management codes make it easier to bill for clinically meaningful months that previously fell below older minimums. That matters for step-down monitoring, mid-month starts, and cohorts where daily device adherence is unrealistic but intermittent physiologic signal still changes care.

RTM becomes much more flexible for short monitoring windows. New 2–15 day RTM device codes and a shorter initial RTM management code align better with musculoskeletal and respiratory therapy patterns, where intense monitoring often happens early and tapers appropriately.

APCM can now be paired with behavioral health integration at scale. New APCM behavioral health add-on codes create a clearer pathway to systematically layer structured behavioral health support into monthly primary care management, rather than treating it as a separate, fragile workflow.

If you’re building programs in 2026, the strategic implication is simple: tiered, clinically honest remote care models are easier to operationalize than they were in 2025.

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Understanding the building blocks of remote and preventive care

Before diving into codes, it helps to see these programs as a connected ecosystem rather than separate billing opportunities. AWVs identify risk and care gaps. CCM and APCM create a monthly operating cadence. PCM concentrates effort on one serious condition when that condition is the driver of risk. RPM and RTM provide signal that helps the team decide who needs attention today. TCM protects the patient during the fragile 30-day post-discharge window and feeds the patient back into longitudinal management.

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Remote Patient Monitoring (RPM) codes in 2026

RPM is designed around physiologic data captured outside the clinic (blood pressure, glucose, weight, oxygen saturation) and used to trigger clinical action. In high-performing programs, the clinical loop is clear: data comes in, signal is triaged, outreach happens, decisions are documented, and the patient’s plan changes in a way that reduces risk.

A realistic RPM vignette is a hypertension patient whose readings drift upward after a medication change and a sleep disruption. The practice doesn’t need a 30-minute intervention to create value. Ten to fifteen minutes of trend review, outreach, medication reconciliation, and targeted adjustment is often what prevents the problem from becoming an urgent visit.

In 2026, RPM becomes easier to run with tiered intensity. You can build a high-touch mode for unstable patients and a low-touch, responsive mode for stable or step-down patients, without forcing daily readings just to satisfy a billing mechanic.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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A practical implementation insight for 2026 is to explicitly define two RPM pathways. One pathway is “high-touch”: daily or near-daily readings, more frequent interventions, and management time that often reaches the higher thresholds. The other pathway is “low-touch but clinically responsive”: fewer device days, fewer but decisive interventions, and consistent documentation of interactive communication when required. Most programs fail because they try to run both pathways with the same template and the same staff expectations, which creates confusion at month-end.

How Lara Health supports this: Lara Health turns RPM into a structured workflow: eligibility checks, onboarding scripts, consistent time capture, and month-level artifacts that connect data trends to clinical actions. The goal is not to push more monitoring; it is to make monitoring clinically disciplined and reliably billable.

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Remote Therapeutic Monitoring (RTM) codes in 2026

RTM is designed for non-physiologic or therapeutically relevant data: therapy adherence, symptoms, pain scores, range of motion, respiratory flow measures, or other signals that help clinicians manage therapeutic response between visits. RTM is particularly relevant in musculoskeletal and respiratory settings, where care is often episodic and where adherence is the difference between recovery and relapse.

The clinical vignette here is familiar in physical therapy: the patient starts strong, then quietly falls off the home program. Pain scores rise, range of motion plateaus, and the practice doesn’t learn about it until the next appointment. RTM allows earlier detection and earlier adjustment, and the 2026 updates make that monitoring far more compatible with short episodes.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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In 2026, the discipline that separates strong RTM programs from weak ones is “interactive communication as a workflow element.” If your program is entirely asynchronous, you will struggle with codes that require real-time interactive communication. The fix is not to create artificial phone calls; it’s to design clinically appropriate touchpoints that naturally occur when the data suggests a change is needed, and then capture that touchpoint consistently.

How Lara Health supports this: Lara Health makes RTM operationally legible: device-day logic is visible, touchpoints are prompted when clinically needed, and month-end documentation connects therapeutic data to decisions and follow-up. That keeps the program defensible without burying therapists or clinicians in administrative work.

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Chronic Care Management (CCM) codes in 2026

CCM is the backbone of reimbursable non-face-to-face care coordination for patients with multiple chronic conditions. It is the “monthly operating system” that turns disconnected visits into continuity: medication reconciliation, care plan updates, coordination with specialists, and proactive outreach that prevents acute exacerbations.

The CCM vignette is not glamorous, but it’s where outcomes are won: a care manager discovers that a patient is taking two beta blockers prescribed by different clinicians, reconciles the regimen, and prevents hypotension-related falls. Or a patient with diabetes and depression is not failing because of insulin—it’s failing because sleep collapse and anhedonia have destroyed routines. CCM is how that reality becomes part of the medical plan rather than an unspoken explanation.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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The most important implementation insight for CCM is to build a monthly close ritual. You need a repeatable process that ensures consent is on file, the care plan is updated, time is attributed correctly, and time is not double-counted with other programs. Without that ritual, CCM becomes a fragile billing exercise rather than a clinical operating system.

How Lara Health supports this: Lara Health structures CCM as a repeatable monthly workflow with built-in time capture and documentation prompts, producing month-level artifacts that reduce denials and make audit readiness routine.

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Principal Care Management (PCM) codes in 2026

PCM is the condition-focused counterpart to CCM. It pays for monthly management of one serious chronic condition expected to last at least three months and to place the patient at significant risk of hospitalization, acute exacerbation, functional decline, or death. PCM is especially valuable in specialty care and in primary care during high-risk flare periods when one condition dominates the patient’s trajectory.

A cardiology PCM vignette looks like this: a heart failure patient needs tight medication titration, early symptom detection, and coordination with pharmacy and home monitoring, work that is clinically essential but often under-recognized in a visit-based model. PCM is how that work becomes a structured, reimbursable program.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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A common scaling pattern is “PCM first, then CCM/APCM.” A specialist stabilizes one serious condition with PCM, then the primary care team transitions the patient into CCM or APCM as multi-morbidity coordination becomes the dominant need. The key operational requirement is clean attribution: avoid overlapping time and ensure each program’s service elements are independently met.

How Lara Health supports this: Lara Health enables condition-specific pathways so PCM doesn’t collapse into generic time logging. It structures the plan, captures actions and time, and keeps attribution clean when patients also participate in monitoring or broader care management.

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Advanced Primary Care Management (APCM) codes in 2026

APCM is designed for primary care practices that serve as the continuing focal point for a patient’s care and can deliver a defined set of advanced primary care capabilities. Unlike strictly time-based codes, APCM is built to support operational maturity: continuity, access, care planning, and population-health activities as part of monthly management.

In 2026, APCM becomes even more strategically important because CMS has created behavioral health integration add-ons that allow practices to systematically layer behavioral health support onto monthly primary care management.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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A key APCM implementation insight is to treat APCM as an operating model, not a billing code. If you cannot describe who owns monthly outreach, who updates care plans, how after-hours access is provided, and how coordination is documented, APCM will not scale. The new behavioral health add-ons increase both opportunity and responsibility: if you bill them, your documentation should clearly show programmatic behavioral health integration rather than ad hoc counseling.

How Lara Health supports this: Lara Health helps practices run APCM as a standardized cadence: task orchestration, patient engagement, documentation prompts, and month-end processes that make integrated care measurable and defensible.

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Transitional Care Management (TCM) codes in 2026

TCM pays for the 30-day coordination period after discharge, when patients are fragile and the risk of readmission is high. Operationally, TCM succeeds or fails based on the two critical timing requirements: prompt interactive contact after discharge and a timely face-to-face visit tied to medical decision-making complexity.

A TCM vignette is the patient discharged with multiple medication changes and a confusing plan. If your team contacts them within two business days, reconciles meds, and schedules the visit within the required timeframe, you prevent the “post-discharge cliff” where small misunderstandings become major setbacks.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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TCM is often one of the highest-value code families in primary care, yet it’s commonly missed because the work is distributed across staff and days. The fix is simple but non-negotiable: a discharge capture workflow, an outreach workflow that logs contact attempts and success, and a scheduling workflow that protects the face-to-face deadline. Without those three elements, your team still does the work—but your billing becomes inconsistent.

How Lara Health supports this: Lara Health turns TCM into a playbook: discharge capture, outreach tracking, scheduling prompts, reconciliation templates, and a month-level artifact that makes compliance evidence easy to assemble.

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Annual Wellness Visits (AWVs) in 2026

AWVs are the preventive anchor and one of the most effective enrollment engines into longitudinal programs. They are not acute problem visits; they are structured risk assessment, prevention planning, and care-gap identification. In practices that treat AWVs as a system, AWVs become the pipeline that fills CCM/APCM panels, identifies who needs monitoring, and creates a measurable prevention strategy.

Note: These are approximate national non-facility Medicare payments computed from RVU26A total non-facility RVUs × the non-QP CY 2026 conversion factor; actual payment varies by locality, site of service, and payer.

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The operational insight is to treat AWV as the front door into longitudinal care. The most effective practices build a “same-day next step” workflow: patients who qualify and consent can be enrolled into CCM/APCM, and high-risk cohorts can be offered RPM or RTM pathways as clinically appropriate. AWV done this way stops being a seasonal project and becomes a predictable pipeline.

How Lara Health supports this: Lara Health helps practices run AWVs as a repeatable workflow with standardized templates and direct linkage into care management enrollment and documentation.

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Implementation strategy for 2026: how to start without chaos

A successful remote care build in 2026 is phased and operationally humble. Most practices don’t fail because they misunderstand medicine; they fail because they try to run seven code families without a unified consent process, a unified time attribution method, and a month-end close ritual.

A practical staged rollout looks like this:

Start with your pipeline. Use AWVs to identify the cohort and to capture consent where appropriate. Build a simple enrollment script that explains what the program is, how patients can opt out, and the fact that cost-sharing may apply depending on payer.

Then build one monthly operating cadence. Decide who owns outreach, how you triage signals, and how you document the care plan changes that result. If you can’t describe the cadence in one page, you don’t have a cadence.

Finally, build month-end close. Decide who reviews completeness, where missing elements are resolved, and how you ensure time is not counted twice. In most practices, month-end close is the single most important operational control for compliance and revenue reliability.

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ROI and financial impact: a clean example with real-life math

Remote care ROI is usually won or lost on operational leakage, not on nominal reimbursement amounts. Leakage is the fraction of clinically delivered service months that fail to become clean claims because documentation is incomplete, interactive communication isn’t captured, or time is double-counted.

An illustrative example: suppose you enroll 200 patients in non-complex CCM (99490) and you run a conservative, stable program where only 70% of enrolled patient-months are cleanly billable for the first quarter because documentation workflows are still stabilizing. If you improve capture to 90% by month four through better templates, better time attribution, and a structured close process, the incremental lift is not subtle - it’s the difference between a program that funds staffing sustainably and a program that feels like “extra work for uncertain pay.”

The point is not that every patient should be enrolled. The point is that once you decide a cohort is clinically appropriate, your workflow should make capture predictable. That’s what allows you to staff confidently and scale responsibly.

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Common pitfalls and how to avoid them

The first pitfall is double-counting time across programs. RPM, RTM, CCM, and PCM can interact in the same month in real clinical life, but time must be attributed carefully, and you should design workflows that assign time to one bucket in real time rather than allocating it after the fact.

The second pitfall is ignoring interactive communication requirements in RPM and RTM management codes. If a code requires a real-time interactive communication, build the touchpoint into your clinical playbook and capture it consistently. When you rely on memory, you create denial risk.

The third pitfall is treating device-day thresholds as a billing afterthought. In 2026, short-window device supply codes make tiering easier - but only if your system can count device days consistently and your team has a shared definition of what counts as a “day with data.”

The fourth pitfall is underinvesting in audit readiness. Audit readiness is not defensive charting; it’s operational clarity. You should be able to show why the service was necessary, what was done, what changed because of the work, and where the evidence lives.

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Compliance and audit readiness: what your chart should make easy to prove

A strong program produces the same artifacts every month, without heroics:

• Documented consent when required and evidence of patient understanding.
• A care plan that is accessible, updated, and consistent with the work performed.
• A clear record of what data was reviewed (RPM/RTM) and what action was taken.
• A record of interactive communication when required.
• Clean time attribution that is not double-counted across code families.
  

When those artifacts are produced as a byproduct of workflow rather than an after-the-fact scramble, both denials and clinician burnout fall.

Remote care billing is not about memorizing codes. It’s about building a care operating system where consent, documentation, time attribution, and clinical loop closure happen naturally, so your team can deliver better outcomes and your practice can sustain that work financially.

Ready to modernize your remote care operations for 2026? Lara Health’s platform automates eligibility checks, documentation prompts, time tracking, and audit-ready reporting across RPM, CCM, PCM, APCM, RTM, TCM, and AWVs, enabling your staff to focus on patients while the system protects compliance. Book a demo with Lara Health and see what remote care looks like when workflows are truly built for it.

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FAQs

Can RPM and CCM be billed in the same month?

Often, yes, if each program’s requirements are independently met and time is not double-counted. The operational key is clean attribution: your team should know, in the moment, whether work is CCM coordination or RPM management.

What’s the practical difference between RPM and RTM?

RPM is physiologic monitoring (vital sign–type data). RTM is therapeutic monitoring (often adherence and response) in musculoskeletal and respiratory care pathways.

How often can AWVs be billed?

AWV frequency has a 12-month cadence. Each payer might have their own guideline on billing but generally practices adopt 12-montn window.

What’s new in 2026 that changes remote care program design?

The main design improvements are short-window device supply codes and short-threshold management codes in RPM and RTM, plus APCM behavioral health add-ons that support scaled integration.

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Sources

CMS: CY 2026 PFS final rule fact sheet (CMS-1832-F).

CMS: PFS Relative Value Files (RVU26A / PPRRVU 2026 January release).

CMS MLN: Chronic Care Management Services booklet (MLN909188, 2025 update).

CMS MLN: Therapy Code List—2026 annual update (MM14250) for RTM updates.

CMS MLN: TCM and AWV booklets (most recent versions).