Article Sections
Overview
ThoroughCare is proactively updating our platform to align with the 2026 CMS Physician Fee Schedule regulation changes. To ensure a seamless transition for your practice, these changes will automatically be available in the system starting January 1, 2026. No manual configuration is required, allowing your team to focus on patient care from day one of the new year.
RPM 10-19 Minute Reading Code (99470)
To provide greater flexibility in patient management, ThoroughCare now supports the new reimbursement threshold for 10-19 minutes of clinical staff time in the Remote Physiologic Monitoring (RPM) program.
Automatic Logic: The system will automatically generate the corresponding billing code once a patient reaches 10 minutes of billable time within the calendar month.
Enhanced Visibility: We have introduced a new dashboard bucket on the RPM overview page. This allows clinicians to quickly identify and manage patients who have reached the 10-minute threshold but have not yet reached the 20-minute mark, ensuring no billable activity is overlooked.
RPM 2-15 days with Readings Code (99445)
CMS has introduced a lower threshold for device supply reimbursement, and ThoroughCare is updated to capture these opportunities.
Qualification: Patients will now qualify for the new device supply code after reaching a minimum of 2 days with readings per month, mirroring the logic of the existing 16-day requirement.
Dashboard Update: To reflect this change, the Qualified Supplied Device section on the RPM dashboard will now display patients who have met the 2-day minimum, replacing the previous 16-day requirement. This provides a more accurate view of your billable device claims early in the month.
RTM 10-19 Minute Code (98979)
Similar to the updates for RPM, ThoroughCare now supports the new 10-19 minute treatment management code for Remote Therapeutic Monitoring (RTM).
Logic: This code will be automatically generated once a patient reaches 10 minutes of documented billable time within the RTM program. This ensures that even shorter clinical check-ins that provide patient value are recognized for reimbursement.
RTM 2-15 Days with Readings Code (98984, 98985, 98986)
ThoroughCare has also integrated the new 2-15 days with readings code for RTM.
Qualification: A patient will qualify for this code after reaching at least 2 days with readings within the month. This follows the same logic as the traditional 16-day requirement but allows for reimbursement in cases where 16 days of monitoring may not be clinically necessary or achieved.
G0136 Assessment Changes
The G0136 code is seeing a significant shift in its application. ThoroughCare has updated the system to transition this code from its previous focus on Health-Related Social Needs (HRSN) to the new Nutrition and Physical Activity Risk Assessment.
Assessment Access: Users can access this updated assessment as a standalone tool or as a component within the Annual Wellness Visit (AWV) workflow.
Compliance: This change ensures your practice meets the updated CMS requirements for assessing physical activity and nutritional risks as part of preventative care.
APCM Behavioral Health Add-on Codes (G0568, G0569, G0570)
For practices participating in Advanced Primary Care Management (APCM), ThoroughCare is adding robust support for managing Behavioral Health Integration (BHI) and Collaborative Care Model (CoCM) add-on codes.
Direct Management: Users will now be able to manually manage APCM claim add-on codes directly from the Billing and Claims Worklist.
Flexibility: This update allows billing teams to directly add or remove behavioral health add-on codes to specific APCM claims, providing the control needed to ensure accurate and compliant billing for integrated behavioral health services.
To learn more about APCM claims in ThoroughCare, please click here.