Healthcare Billing & Care Program Glossary
Plain-English definitions of the CMS billing codes, care programs, and compliance terms referenced across Positive Check's provider resources. Each entry links to its primary CMS source.
What this section covers
- CMS billing codes — CPT codes used for Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Transitional Care Management (TCM) programs.
- Care program terms — Definitions of RPM, CCM, TCM, Principal Care Management, and Annual Wellness Visit.
- Compliance terms — HIPAA, Business Associate Agreement (BAA), ePHI, HITECH Act.
- Clinical & operational terms — 30-day readmission, interactive communication requirement, care coordination, patient engagement.
Current entries
CMS billing code
CPT 99495
Medicare TCM code for moderate-complexity post-discharge care.
CMS billing code
CPT 99496
Medicare TCM code for high-complexity post-discharge care.
Care program
Transitional Care Management (TCM)
CMS-reimbursed care model for post-discharge transitions.
Clinical outcome
30-day readmission
Unplanned inpatient admission within 30 days of prior discharge; HRRP context.
Clinical operations
Care coordination
Deliberate organization of patient care activities across participants.
CMS billing code
CPT 99453
Medicare RPM one-time setup and patient education.
CMS billing code
CPT 99454
Medicare RPM device supply with daily recordings, each 30 days.
CMS billing code
CPT 99457
First 20 minutes of RPM interactive communication per month.
CMS billing code
CPT 99458
Each additional 20 minutes of RPM interactive communication per month.
CMS billing code · New for 2026
CPT 99445
RPM device supply when data is transmitted on 2 to 15 days within a 30-day period.
CMS billing code · New for 2026
CPT 99470
First 10 minutes of RPM treatment management per calendar month.
Care program
Remote Patient Monitoring (RPM)
Medicare-reimbursed care model combining device data transmission with monthly interactive communication.
CMS billing code
CPT 99490
First 20 minutes of non-complex Chronic Care Management clinical staff time per month.
CMS billing code
CPT 99439
Each additional 20 minutes of non-complex CCM (up to 2x per patient per month).
CMS billing code
CPT 99487
First 60 minutes of complex Chronic Care Management per month.
CMS billing code
CPT 99489
Each additional 30 minutes of complex CCM beyond the 99487 threshold.
Care program
Chronic Care Management (CCM)
Medicare-reimbursed care coordination program for patients with two or more chronic conditions.
Compliance
HIPAA Compliance
Adherence to HIPAA rules governing how covered entities and business associates handle Protected Health Information.
Compliance
Business Associate Agreement (BAA)
HIPAA-required contract between covered entities and vendors handling PHI on their behalf.
Compliance
ePHI
Electronic Protected Health Information — the subset of PHI covered by the HIPAA Security Rule.
Compliance
HITECH Act
2009 law that expanded HIPAA enforcement, created breach notification, and funded EHR adoption.
Care program
Principal Care Management (PCM)
Medicare-reimbursed care management for a single high-risk chronic condition (CPT 99424–99427).
Care program
Annual Wellness Visit (AWV)
Medicare-covered yearly preventive visit establishing a personalized prevention plan (HCPCS G0438/G0439).
CMS requirement
Interactive communication requirement
CMS rule defining real-time two-way clinical engagement for RPM and related code billing.
Clinical operations
Patient engagement
Active, structured involvement of patients in their own care — core to CCM, RPM, TCM, and PCM outcomes.
Entries are added on an ongoing basis as Positive Check publishes new provider-facing content. For questions about a term not yet listed, contact our team.