If you’re building or selling a digital health solution in the US, here’s something that might not be getting enough attention in your go-to-market plans: Current Procedural Terminology (CPT®) codes. Not because your clinical champion mentioned them. But because CPT codes still drive most of the revenue that providers actually receive.
This gets missed. Founders often focus on usability, clinical outcomes, or engagement metrics. But buyers—especially those on the revenue cycle, population health, or financial ops side—are evaluating something else too: will this solution generate billable activity? If the answer is no, the road to contract signature gets a lot longer. Maybe even closed.
CPT Codes Are More Than Billing
CPT codes are the system by which healthcare providers get paid in the US. Every reimbursable service—an office visit, a lab draw, a medication management conversation—has a corresponding code. And those codes tie directly to payment.
That’s obvious to most billing teams. But it’s often overlooked by digital health leaders who haven’t operated within a clinic or hospital system. Even as more providers shift toward value-based care, CPT codes are still the mechanism by which performance is tracked, outcomes are documented, and revenue flows.
So when a buyer asks how your solution supports reimbursement, they’re not just asking about financial ROI. They’re asking whether your solution is operationally aligned with how care gets documented, coded, and paid for.
The Codes That Are Sitting Unused
Let’s look at five CPT code sets that are underused today—but fully reimbursable. If your solution can enable, simplify, or automate these workflows, you’re not just making care better. You’re unlocking real revenue.
Chronic Pain Management (G3002, G3003)
These CPT codes were introduced by CMS in 2023. They cover structured monthly care for patients with chronic pain, including assessment tools, care plan documentation, and behavioral health coordination.
G3002 pays about $79.01 for the first 30 minutes per month. G3003 adds ~$28.76 for each 15-minute increment after that. So if a provider ended up doing an hour of chronic pain management in a month, they’d get ~$79 + $28.76 + $28.76 (for 60 minutes total).
What’s the blocker? Clinics often don’t have a repeatable workflow to document that time or coordinate those tasks. If your solution helps track assessments and time spent, you’re enabling a new, recurring revenue stream.
Remote Physiologic Monitoring (99457, 99458)
Remote monitoring is no longer new, but it’s still underutilized outside cardiology and high-acuity care. 99457 pays about $47.87 for 20 minutes of clinical monitoring and care coordination. 99458 pays another ~$38.49 for each additional 20 minutes. For complex patients, multiple increments are possible (e.g., 60 minutes of remote management yields ~ $47.87 + $38.49 + $38.49 ≈ $125).
The catch? Clinics need to prove the time spent, and ensure the work is tied to actual clinical use. Many practices don’t have a clean way to track or document this. Digital health solutions that automate alerts, facilitate documentation, and confirm patient adherence make this billable activity possible at scale.
Transitional Care Management (99495, 99496)
This is one of the most missed billing opportunities. When a patient is discharged from the hospital, providers can bill for managing that transition—if they contact the patient within two business days and schedule a follow-up visit in the right window.
99495 pays ~$203 for moderate complexity (follow-up within 14 days). 99496 pays ~$275 for high complexity (follow-up within 7 days). Many clinics simply don’t have the staffing to manage that window. If your solution helps automate discharge alerts and outreach (even via telehealth), this becomes low-effort, high-reward revenue.
Advance Care Planning (99497)
Medicare reimburses up to ~$86 for a 30-minute documented conversation about end-of-life preferences. Yet, national reporting data suggests the actual billing rate for CPT 99497 remains low. The conversations are sensitive, yes—but the bigger blocker is time, training, and documentation.
Digital solutions that guide these conversations or allow for structured documentation are well-positioned to increase adoption here. For primary care networks focused on value-based care metrics, these conversations also contribute to quality scores.
Principal Care Management (99424–99427)
These codes are still relatively new (2020), aimed at patients with one serious chronic condition. Think diabetes, COPD, or heart failure. Where Chronic Care Management (CCM) requires two or more conditions, PCM only requires one. That opens up a wider swath of the population. And PCM CPT codes are reimbursed at between ~$48 to ~$84.
The challenge? Many providers don’t know this exists. Or they think it conflicts with CCM. If your platform manages care plans, captures time, and supports non-face-to-face clinical work, you can help activate this billing path.
Table of Underused CPT Codes
| CPT Code(s) | Service Type | Approx. Reimbursement | Why It’s Underused |
| G3002, G3003 | Chronic Pain Management | $79.01 + $28.76/15min | New in 2023; few workflows exist |
| 99457, 99458 | Remote Physiologic Monitoring | $47.87 + $38.49/20min | Outside cardiology, few teams track time/documentation reliably |
| 99495, 99496 | Transitional Care Management | $203–$275 | Time-sensitive window often missed post-discharge |
| 99497 | Advance Care Planning | $86/30min | Sensitive topic; documentation burden |
| 99424–99427 | Principal Care Management | ~$48–$84 | Confusion around eligibility, newer codes |
What This Means for You
If you’re a founder or GTM leader, this is the part where you translate product features into financial impact. Not just how your solution improves outcomes, but how it supports billable activity. If you enable any of these CPT workflows, you’re directly contributing to net-new revenue.
That makes your pitch clearer, your buyer’s decision easier, and your pricing model more defensible. This is the language health systems already speak. You’re just aligning with it.
If you’re unsure whether your solution fits, start here: does your product enable a clinical service that’s tied to a billable code? If yes, build the workflow. If not, ask yourself what other revenue-linked metrics you influence. But don’t ignore the billing layer. It’s how providers get paid—and how you’ll get bought.
How I Help
If you’re a digital health founder trying to make sense of CPT alignment—or you’re navigating how to tie your solution to net-new revenue streams—this is where I come in.
I work directly with revenue leaders to connect product strategy with what actually shows up in a provider’s billing system. That includes go-to-market messaging, sales enablement, and pricing that mirrors real-world reimbursement.
You don’t need to become a reimbursement expert. But someone on your side should be. If you need help, reach out to me at astrunk@accretiveedge.com.
Disclaimer: This information is accurate as of April 2025.
