CPT Code Calculator | Accurate Medical Billing & RVU Tools

CPT	Description	2025	2026	Change	Delta
99453	RPM Initial Setup & Education	$21.64	$21.71	+0.07	0.3%
99445	RPM Device Supply (2-15 days)	—	$47.43	+47.43	NEW
99454	RPM Device Supply (16+ days)	$47.27	$47.43	+0.16	0.3%
99470	RPM Mgmt (10-19 min)	—	$26.05	+26.05	NEW
99457	RPM Mgmt (First 20 min)	$51.60	$51.77	+0.17	0.3%
99458	RPM Mgmt (Each Addl 20 min)	$41.28	$41.42	+0.14	0.3%
99091	Physiological Data Collection (30 min)	$38.28	$38.41	+0.13	0.3%
98975	RTM Initial Setup & Education	$21.64	$21.71	+0.07	0.3%
98976	RTM Respiratory Device Supply (16-30 days)	$46.94	$47.09	+0.16	0.3%
98984	RTM Respiratory Device Supply (2-15 days)	—	$47.09	+47.09	NEW
98977	RTM MSK Device Supply (16-30 days)	$39.62	$39.75	+0.13	0.3%
98985	RTM MSK Device Supply (2-15 days)	—	$39.75	+39.75	NEW
98979	RTM Mgmt (First 10 min)	—	$26.05	+26.05	NEW
98980	RTM Mgmt (First 20 min)	$53.60	$53.77	+0.18	0.3%
98981	RTM Mgmt (Each Addl 20 min)	$41.61	$41.75	+0.14	0.3%
99490	CCM clinical staff, 20 min	$65.91	$66.13	+0.22	0.3%
99439	CCM each additional 20 min	$50.27	$50.43	+0.17	0.3%
99487	Complex CCM, 60 min	$143.81	$144.29	+0.48	0.3%
99489	Complex CCM add-on, 30 min	$77.90	$78.16	+0.26	0.3%
99491	Physician CCM, 30 min	$88.55	$88.84	+0.29	0.3%
99437	Physician CCM add-on, 30 min	$63.25	$63.46	+0.21	0.3%
99424	PCM Physician/QHP, 30 min	$87.22	$87.51	+0.29	0.3%
99425	PCM Physician Add-on, 30 min	$61.25	$61.46	+0.20	0.3%
99426	PCM Clinical Staff, 30 min	$63.25	$63.46	+0.21	0.3%
99427	PCM Staff Add-on, 30 min	$45.27	$45.42	+0.15	0.3%
99492	Initial CoCM, 70 min	$148.81	$149.30	+0.49	0.3%
99493	Subsequent CoCM, 60 min	$135.49	$135.94	+0.45	0.3%
99494	CoCM add-on, 30 min	$59.92	$60.12	+0.20	0.3%
G2214	CoCM limited time, 30 min	$49.94	$50.10	+0.16	0.3%
99484	General BHI, 20 min	$54.26	$54.44	+0.18	0.3%
G0323	Psychologist/CSW BHI, 20 min	$43.28	$43.42	+0.14	0.3%
G0568	Initial CoCM under APCM	—	$149.30	+149.30	NEW
G0569	Subsequent CoCM under APCM	—	$135.94	+135.94	NEW
G0570	General BHI under APCM	—	$54.44	+54.44	NEW
99202	Office Visit New, Low	$70.57	$70.81	+0.23	0.3%
99203	Office Visit New, Moderate	$111.85	$112.22	+0.37	0.3%
99204	Office Visit New, High	$168.11	$168.67	+0.56	0.3%
99205	Office Visit New, Extended	$223.04	$223.78	+0.74	0.3%
99211	Office Visit Est, Nurse	$22.97	$23.05	+0.08	0.3%
99212	Office Visit Est, 10-19 min	$57.26	$57.45	+0.19	0.3%
99213	Office Visit Est, 20-29 min	$90.88	$91.18	+0.30	0.3%
99214	Office Visit Est, 30-39 min	$127.50	$127.92	+0.42	0.3%
99215	Office Visit Est, 40-54 min	$178.77	$179.36	+0.59	0.3%
G2211	Visit Complexity Add-on	$16.31	$16.37	+0.05	0.3%
99221	Initial Hospital Care, Low	$82.89	$83.17	+0.27	0.3%
99222	Initial Hospital Care, Moderate	$116.18	$116.57	+0.38	0.3%
99223	Initial Hospital Care, High	$155.80	$156.31	+0.51	0.3%
99231	Subsequent Hospital Care, Low	$36.95	$37.07	+0.12	0.3%
99232	Subsequent Hospital Care, Moderate	$59.92	$60.12	+0.20	0.3%
99233	Subsequent Hospital Care, High	$106.53	$106.88	+0.35	0.3%
99238	Hospital Discharge, <= 30 min	$57.59	$57.78	+0.19	0.3%
99239	Hospital Discharge, > 30 min	$86.55	$86.84	+0.29	0.3%
99281	ED Visit, Level 1	$10.99	$11.02	+0.04	0.3%
99282	ED Visit, Level 2	$40.61	$40.75	+0.13	0.3%
99283	ED Visit, Level 3	$68.91	$69.14	+0.23	0.3%
99284	ED Visit, Level 4	$117.18	$117.57	+0.39	0.3%
99285	ED Visit, Level 5	$169.45	$170.01	+0.56	0.3%
99291	Critical Care, 30-74 min	$210.39	$211.09	+0.70	0.3%
99292	Critical Care add-on, 30 min	$105.86	$106.21	+0.35	0.3%
G0556	APCM Level 1 (1 chronic condition)	—	$16.37	+16.37	NEW
G0557	APCM Level 2 (2+ chronic conditions)	—	$53.77	+53.77	NEW
G0558	APCM Level 3 (QMB 2+ conditions)	—	$117.23	+117.23	NEW
99341	Home Visit New, 15 min	$48.94	$49.10	+0.16	0.3%
99342	Home Visit New, 30 min	$78.23	$78.49	+0.26	0.3%
99344	Home Visit New, 60 min	$147.14	$147.63	+0.49	0.3%
99345	Home Visit New, 75 min	$209.39	$210.09	+0.69	0.3%
99347	Home Visit Est, 20 min	$45.94	$46.09	+0.15	0.3%
99348	Home Visit Est, 30 min	$78.23	$78.49	+0.26	0.3%
99349	Home Visit Est, 40 min	$131.83	$132.26	+0.44	0.3%
99350	Home Visit Est, 60 min	$192.42	$193.05	+0.64	0.3%
90832	Psychotherapy, 30 min	$85.56	$85.84	+0.28	0.3%
90833	Psychotherapy add-on, 30 min	$81.23	$81.50	+0.27	0.3%
90834	Psychotherapy, 45 min	$113.52	$113.89	+0.38	0.3%
90836	Psychotherapy add-on, 45 min	$102.87	$103.21	+0.34	0.3%
90837	Psychotherapy, 60 min	$166.45	$167.00	+0.55	0.3%
90846	Family Psychotherapy (w/o patient)	$94.88	$95.19	+0.31	0.3%
90847	Family Psychotherapy (w/ patient)	$109.19	$109.55	+0.36	0.3%
96116	Neurobehavioral Status Exam	$93.88	$94.19	+0.31	0.3%
96127	Brief Emotional/Behavioral Assessment	$4.33	$4.34	+0.01	0.3%
G0438	Annual Wellness Visit (Initial)	$159.79	$160.32	+0.53	0.3%
G0439	Annual Wellness Visit (Subsequent)	$105.53	$105.88	+0.35	0.3%
99497	Advance Care Planning (30 min)	$86.55	$86.84	+0.29	0.3%
G0442	Alcohol Screening (15 min)	$16.31	$16.37	+0.05	0.3%
G0444	Depression Screening (15 min)	$16.31	$16.37	+0.05	0.3%
G0136	SDOH Risk Assessment	$16.31	$16.37	+0.05	0.3%
99406	Smoking Cessation (3-10 min)	$13.32	$13.36	+0.04	0.3%
99459	Pelvic Exam	$22.97	$23.05	+0.08	0.3%
90480	COVID-19 Vaccine Admin	$39.95	$40.08	+0.13	0.3%
G0008	Flu Vaccine Admin	$34.62	$34.74	+0.11	0.3%
93306	TTE (Echo) Complete	$162.46	$162.99	+0.54	0.3%
95810	Polysomnography (Sleep Study)	$456.07	$457.58	+1.51	0.3%
74177	CT Abdomen/Pelvis w/ Contrast	$182.10	$182.70	+0.60	0.3%
70553	MRI Brain w/o & w/ Contrast	$409.47	$410.82	+1.35	0.3%
66984	Cataract Surgery w/ IOL	$461.40	$462.92	+1.52	0.3%
27447	Total Knee Arthroplasty	$1121.87	$1125.58	+3.71	0.3%
45380	Colonoscopy w/ Biopsy	$307.60	$308.62	+1.02	0.3%
17110	Benign Lesion Destruction (1-14)	$61.92	$62.12	+0.20	0.3%
20611	Major Joint Injection w/ US	$50.60	$50.77	+0.17	0.3%
77067	Screening Mammography	$131.50	$131.93	+0.43	0.3%
87591	Gonorrhea NAAT	$25.30	$25.38	+0.08	0.3%
36415	Venipuncture	$3.00	$3.01	+0.01	0.3%
G2212	Prolonged Services (15 min)	$35.29	$35.40	+0.12	0.3%
99495	TCM Moderate Complexity	$194.41	$195.06	+0.64	0.3%
99496	TCM High Complexity	$249.34	$250.17	+0.82	0.3%

CPT

Description

2025

2026

Change

Delta

99453

RPM Initial Setup & Education

$21.64

$21.71

+0.07

0.3%

99445

RPM Device Supply (2-15 days)

—

$47.43

+47.43

NEW

99454

RPM Device Supply (16+ days)

$47.27

$47.43

+0.16

0.3%

99470

RPM Mgmt (10-19 min)

—

$26.05

+26.05

NEW

99457

RPM Mgmt (First 20 min)

$51.60

$51.77

+0.17

0.3%

99458

RPM Mgmt (Each Addl 20 min)

$41.28

$41.42

+0.14

0.3%

99091

Physiological Data Collection (30 min)

$38.28

$38.41

+0.13

0.3%

98975

RTM Initial Setup & Education

$21.64

$21.71

+0.07

0.3%

98976

RTM Respiratory Device Supply (16-30 days)

$46.94

$47.09

+0.16

0.3%

98984

RTM Respiratory Device Supply (2-15 days)

—

$47.09

+47.09

NEW

98977

RTM MSK Device Supply (16-30 days)

$39.62

$39.75

+0.13

0.3%

98985

RTM MSK Device Supply (2-15 days)

—

$39.75

+39.75

NEW

98979

RTM Mgmt (First 10 min)

—

$26.05

+26.05

NEW

98980

RTM Mgmt (First 20 min)

$53.60

$53.77

+0.18

0.3%

98981

RTM Mgmt (Each Addl 20 min)

$41.61

$41.75

+0.14

0.3%

99490

CCM clinical staff, 20 min

$65.91

$66.13

+0.22

0.3%

99439

CCM each additional 20 min

$50.27

$50.43

+0.17

0.3%

99487

Complex CCM, 60 min

$143.81

$144.29

+0.48

0.3%

99489

Complex CCM add-on, 30 min

$77.90

$78.16

+0.26

0.3%

99491

Physician CCM, 30 min

$88.55

$88.84

+0.29

0.3%

99437

Physician CCM add-on, 30 min

$63.25

$63.46

+0.21

0.3%

99424

PCM Physician/QHP, 30 min

$87.22

$87.51

+0.29

0.3%

99425

PCM Physician Add-on, 30 min

$61.25

$61.46

+0.20

0.3%

99426

PCM Clinical Staff, 30 min

$63.25

$63.46

+0.21

0.3%

99427

PCM Staff Add-on, 30 min

$45.27

$45.42

+0.15

0.3%

99492

Initial CoCM, 70 min

$148.81

$149.30

+0.49

0.3%

99493

Subsequent CoCM, 60 min

$135.49

$135.94

+0.45

0.3%

99494

CoCM add-on, 30 min

$59.92

$60.12

+0.20

0.3%

G2214

CoCM limited time, 30 min

$49.94

$50.10

+0.16

0.3%

99484

General BHI, 20 min

$54.26

$54.44

+0.18

0.3%

G0323

Psychologist/CSW BHI, 20 min

$43.28

$43.42

+0.14

0.3%

G0568

Initial CoCM under APCM

—

$149.30

+149.30

NEW

G0569

Subsequent CoCM under APCM

—

$135.94

+135.94

NEW

G0570

General BHI under APCM

—

$54.44

+54.44

NEW

99202

Office Visit New, Low

$70.57

$70.81

+0.23

0.3%

99203

Office Visit New, Moderate

$111.85

$112.22

+0.37

0.3%

99204

Office Visit New, High

$168.11

$168.67

+0.56

0.3%

99205

Office Visit New, Extended

$223.04

$223.78

+0.74

0.3%

99211

Office Visit Est, Nurse

$22.97

$23.05

+0.08

0.3%

99212

Office Visit Est, 10-19 min

$57.26

$57.45

+0.19

0.3%

99213

Office Visit Est, 20-29 min

$90.88

$91.18

+0.30

0.3%

99214

Office Visit Est, 30-39 min

$127.50

$127.92

+0.42

0.3%

99215

Office Visit Est, 40-54 min

$178.77

$179.36

+0.59

0.3%

G2211

Visit Complexity Add-on

$16.31

$16.37

+0.05

0.3%

99221

Initial Hospital Care, Low

$82.89

$83.17

+0.27

0.3%

99222

Initial Hospital Care, Moderate

$116.18

$116.57

+0.38

0.3%

99223

Initial Hospital Care, High

$155.80

$156.31

+0.51

0.3%

99231

Subsequent Hospital Care, Low

$36.95

$37.07

+0.12

0.3%

99232

Subsequent Hospital Care, Moderate

$59.92

$60.12

+0.20

0.3%

99233

Subsequent Hospital Care, High

$106.53

$106.88

+0.35

0.3%

99238

Hospital Discharge, <= 30 min

$57.59

$57.78

+0.19

0.3%

99239

Hospital Discharge, > 30 min

$86.55

$86.84

+0.29

0.3%

99281

ED Visit, Level 1

$10.99

$11.02

+0.04

0.3%

99282

ED Visit, Level 2

$40.61

$40.75

+0.13

0.3%

99283

ED Visit, Level 3

$68.91

$69.14

+0.23

0.3%

99284

ED Visit, Level 4

$117.18

$117.57

+0.39

0.3%

99285

ED Visit, Level 5

$169.45

$170.01

+0.56

0.3%

99291

Critical Care, 30-74 min

$210.39

$211.09

+0.70

0.3%

99292

Critical Care add-on, 30 min

$105.86

$106.21

+0.35

0.3%

G0556

APCM Level 1 (1 chronic condition)

—

$16.37

+16.37

NEW

G0557

APCM Level 2 (2+ chronic conditions)

—

$53.77

+53.77

NEW

G0558

APCM Level 3 (QMB 2+ conditions)

—

$117.23

+117.23

NEW

99341

Home Visit New, 15 min

$48.94

$49.10

+0.16

0.3%

99342

Home Visit New, 30 min

$78.23

$78.49

+0.26

0.3%

99344

Home Visit New, 60 min

$147.14

$147.63

+0.49

0.3%

99345

Home Visit New, 75 min

$209.39

$210.09

+0.69

0.3%

99347

Home Visit Est, 20 min

$45.94

$46.09

+0.15

0.3%

99348

Home Visit Est, 30 min

$78.23

$78.49

+0.26

0.3%

99349

Home Visit Est, 40 min

$131.83

$132.26

+0.44

0.3%

99350

Home Visit Est, 60 min

$192.42

$193.05

+0.64

0.3%

90832

Psychotherapy, 30 min

$85.56

$85.84

+0.28

0.3%

90833

Psychotherapy add-on, 30 min

$81.23

$81.50

+0.27

0.3%

90834

Psychotherapy, 45 min

$113.52

$113.89

+0.38

0.3%

90836

Psychotherapy add-on, 45 min

$102.87

$103.21

+0.34

0.3%

90837

Psychotherapy, 60 min

$166.45

$167.00

+0.55

0.3%

90846

Family Psychotherapy (w/o patient)

$94.88

$95.19

+0.31

0.3%

90847

Family Psychotherapy (w/ patient)

$109.19

$109.55

+0.36

0.3%

96116

Neurobehavioral Status Exam

$93.88

$94.19

+0.31

0.3%

96127

Brief Emotional/Behavioral Assessment

$4.33

$4.34

+0.01

0.3%

G0438

Annual Wellness Visit (Initial)

$159.79

$160.32

+0.53

0.3%

G0439

Annual Wellness Visit (Subsequent)

$105.53

$105.88

+0.35

0.3%

99497

Advance Care Planning (30 min)

$86.55

$86.84

+0.29

0.3%

G0442

Alcohol Screening (15 min)

$16.31

$16.37

+0.05

0.3%

G0444

Depression Screening (15 min)

$16.31

$16.37

+0.05

0.3%

G0136

SDOH Risk Assessment

$16.31

$16.37

+0.05

0.3%

99406

Smoking Cessation (3-10 min)

$13.32

$13.36

+0.04

0.3%

99459

Pelvic Exam

$22.97

$23.05

+0.08

0.3%

90480

COVID-19 Vaccine Admin

$39.95

$40.08

+0.13

0.3%

G0008

Flu Vaccine Admin

$34.62

$34.74

+0.11

0.3%

93306

TTE (Echo) Complete

$162.46

$162.99

+0.54

0.3%

95810

Polysomnography (Sleep Study)

$456.07

$457.58

+1.51

0.3%

74177

CT Abdomen/Pelvis w/ Contrast

$182.10

$182.70

+0.60

0.3%

70553

MRI Brain w/o & w/ Contrast

$409.47

$410.82

+1.35

0.3%

66984

Cataract Surgery w/ IOL

$461.40

$462.92

+1.52

0.3%

27447

Total Knee Arthroplasty

$1121.87

$1125.58

+3.71

0.3%

45380

Colonoscopy w/ Biopsy

$307.60

$308.62

+1.02

0.3%

17110

Benign Lesion Destruction (1-14)

$61.92

$62.12

+0.20

0.3%

20611

Major Joint Injection w/ US

$50.60

$50.77

+0.17

0.3%

77067

Screening Mammography

$131.50

$131.93

+0.43

0.3%

87591

Gonorrhea NAAT

$25.30

$25.38

+0.08

0.3%

36415

Venipuncture

$3.00

$3.01

+0.01

0.3%

G2212

Prolonged Services (15 min)

$35.29

$35.40

+0.12

0.3%

99495

TCM Moderate Complexity

$194.41

$195.06

+0.64

0.3%

99496

TCM High Complexity

$249.34

$250.17

+0.82

0.3%

In 2026, CMS implemented a new -2.5% Efficiency Adjustment for most non-time-based services to account for "efficiency gains" in surgical and procedural workflows.

Efficiency Adjustment & PE Impact

⚠ Procedural/Radiology:Directly hit by the -2.5% cut to wRVUs due to "efficiency gains".
✓ Time-Based (RPM/CCM/BHI):EXEMPT from efficiency cuts. CMS is prioritizing longitudinal management.
✓ Office-Based E/M:Exempt from cuts + PE Reallocation favoring office settings over hospital departments.
BHI Add-ons:New G-codes (G0568-G0570) allow billing CoCM/BHI alongside new APCM codes.

Strategy Tip: The 2026 reimbursement landscape represents a massive shift from "procedural" to "relationship-based" care.

Strategies

10-Min Capture (99470)

Turn 15 minutes of nursing time from $0 into revenue. Increases billable volume by ~12%.

Risk Buffer (99445)

Recover 60% of hardware costs for patients who fail the 16-day mark.

BHI Integration (99484)

Leverage BHI add-ons with APCM to double-dip on care management for mental health.

Staff Delegation (99426)

Prioritize staff-led PCM/CCM for 4x higher ROI compared to physician-led activities.

The 2026 Profit Survival Strategy

2025 vs 2026 Rate Matrix

2026 Policy Intelligence

Efficiency Adjustment & PE Impact

Profit Simulator

$249,275.52

$250,099.2

Strategies

10-Min Capture (99470)

Risk Buffer (99445)

BHI Integration (99484)

Staff Delegation (99426)

Get a Custom 2026 Audit-Ready Plan