Since the COVID-19 pandemic, remote patient monitoring has gained considerable popularity. Over 1900% growth has been achieved by remote patient monitoring in the past two years, the fastest growing area in healthcare. In 2020, Current Procedural Terminology (CPT) Code changes allowed doctors to be reimbursed for implementing and running RPM in their practices. Among the most lucrative Medicare care management programs in recent years has been remote patient monitoring (RPM).
How to bill for Remote Patient Monitoring?
Using average RPM reimbursement rates in 2023, if 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, an annual reimbursement will exceed $115,000. This generous reimbursement can largely be attributed to the overhaul of RPM CPT codes in 2020.
Following the identification and enrollment of eligible patients in a remote patient monitoring program, organizations must code their remote patient monitoring services properly in order to capture this reimbursement.
CPT codes for remote patient monitoring and reimbursement rates for 2023
There are four main CPT codes that cover remote patient monitoring as of January 2023: 99453, 99454, 99457, and 99458. Their descriptions and reimbursement rates are as follows:
The CPT number is 99453
Monitoring physiologic parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial setup, and patient education.
Reimbursement rate for 2023: $18.84
The CPT number is 99454
Initiate remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); supply device(s) with daily recording(s) or programmed alert(s) every 30 days.
Reimbursement rate for 2023: $48.93
The CPT number is 99457
Clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver; initial 20 minutes each month
Reimbursement rate for 2023: $47.50
The CPT number is 99458
Medical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver; additional 20 minutes per month.
Reimbursement rate for 2023: $38.68
Documentation Required for Billing RPM
In order to get reimbursed for RPM services, healthcare providers need to take a few things into account. To qualify for Medicare reimbursement, patients must receive a minimum of twenty minutes of service per month as part of RPM. It can be a combination of interactive communications, remote monitoring, and data reporting during this time.
RPM services must also be ordered by a physician or qualified healthcare professional, which includes nurse practitioners, certified nurse specialists, and physician assistants. In some RPM programs, a nurse or care coordinator conducts the initial review and consults with a physician to finalize the interpretation.
Common CPT Codes
CPT codes for remote patient monitoring align with specific services performed, including:
- Initial device setup
- Providing care to a patient
- Using the device on a daily basis.
In addition to initial device setup, daily device use can also only be billed once a month, and daily device use should only be billed on the last calendar day of the month if the patient has taken sixteen daily device readings.
99454 can be billed every 30 days, while 99457 can be billed every month.
CPT Codes for Remote Patient Monitoring: 4 Tips
To make sure you use these RPM codes correctly, follow these four tips:
Regardless of the number of devices used, providers are only allowed to bill 99454 once every 30 days per patient.
It requires at least 20 minutes of logged management time each month to perform remote physiologic monitoring under 99457.
It is possible for a practice to bill 99457 twice per month: once at 40 minutes and once at 60 minutes after 99457 has been billed.
A provider can use RPM codes in conjunction with CCM (using CPT 99487-99490), TCM (via CPT codes 99495-99496), and BHI (code 99484, 99492-99494) during the same period. Bringing together RPM and CCM into a broader, comprehensive care management plan can offer beneficial results for patients and organizations alike.
CPT 99091: What You Need to Know
In the early 2000s, CPT 99091 was created to code remote patient monitoring. Physiologic data collection and interpretation (e.g. electrocardiogram, blood pressure, glucose monitoring) are digitally stored and/or transmitted by the patient and/or caregiver to a physician or other qualified health care professional, qualified through education, training, licensure and regulation (when applicable), requiring a minimum of 30 minutes, each month.
Notes on billing RPM
Check if patients from the pandemic era are eligible
RPM services have become more accessible to a broader group of patients since the COVID-19 pandemic. CMS waived previous restrictions limiting RPM services to only established patients due to the risks and restrictions associated with in-person appointments. As long as previous restrictions continue to be waived, providers can now offer these services to new patients.
Patients with chronic and acute health conditions are now eligible
Furthermore, remote patient monitoring services can now be offered to patients with chronic and acute health conditions. The CMS clarified this in 2021 and it will remain the rule even when the COVID-19 pandemic is over.
Make sure patients understand how to use their devices
Lastly, in order for RPM services to be successful, patients need to be able to communicate with their providers virtually. They should feel comfortable using the tools and technology necessary to receive RPM services effectively.
