Billing Intersection Guide (2026)

• Integrated Billing Allowed: You may bill both the APCM base code and the BH add-on in the same month if the same practitioner furnishes both.
• The New G-Codes:
  • G0568: APCM BH Add-on (Level 1)
  • G0569: APCM BH Add-on (Level 2)
  • G0570: APCM BH Add-on (Level 3)
• The "Either/Or" Rule: Do not bill standalone BHI codes (99492–99494, 99484) alongside the APCM BH add-on. CMS views APCM as a comprehensive bundle.

• No Blanket Ban: You generally can bill APCM and RPM/RTM together, provided requirements for each are met independently.
• Distinct Documentation: Do not double-count minutes.
  (e.g., Time spent reviewing device data cannot count toward APCM care management time).
• 2026 Threshold Updates:
  • 2–15 Days: New codes available for shorter monitoring periods.
  • 10-Minute Increments: New management codes alongside the traditional 20-minute standard.
• One Practitioner Rule: Only one practitioner can bill RPM per patient/month. Never bill RPM and RTM together.

• The -2.5% Efficiency Adjustment: This applies to non-time-based services.
• The Exemption List: Time-based codes (Care Management, BH Therapy) and services on the Telehealth List are exempt.
  Sanity Check: Verify code status before posting.
• RHC / FQHC Update: APCM BH Add-ons (G0568–G0570) have been formally adopted. Coordinate with your MAC on specific edit logic for component reporting.

The FairPath "BillingQ" engine will block claims if these patterns are detected:

• ⛔ Orphaned Add-On: BH Add-on present without a corresponding APCM base code (same month/provider).
• ⛔ Insufficient Data: RPM claim does not meet the day count (2+ or 16+) required by the specific code selected.
• ⛔ Code Stacking: RPM and RTM present on the same invoice.
• ⚠️ Supervision Warning: Virtual direct supervision is finalized, but ensure the practitioner is immediately available.