Your Guide to Chronic Care Remote Patient Monitoring Codes
What are Remote Patient Monitoring (RPM) Services?
While Medicare has been offering reimbursement for the “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring since the beginning of 2018, CPT code 99453, CPT code 99454 and CPT code 99457 were created to monitor and manage patient care needs and better support current RPM services
What are the New Remote Patient Monitoring codes?
CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”*
Which technologies qualify for use with the new codes?
CMS has not specified but has indicated that they will issue guidance at a later time.
Do patients have to consent to receive RPM services?
Patient consent must be obtained and documented in the patients’ medical record.
Is Medicare reimbursement available for setting up RPM devices and education patients?
Part of CPT 99452 includes reimbursement for setting up equipment and educating patients in the use of the equipment
Are there any regional or location requirements to be eligible for RPM reimbursement?
Medicare does not consider Remote Patient Monitoring a telehealth service. Patients can receive reimbursable RPM services at home and they are not limited to patients in rural areas.
Is a Face to Face Exam or Interactive Audio-Video required for Billing RPM?
Generally, no, although if the patient is new, or has not been seen in one year prior to billing RPM, a face-to-face encounter is required (e.g., an annual wellness visit)
Will Billing RPM Services interfere with Billing for Chronic Care Management (CCM)?
Although double counting is not permitted, providers can bill both CPT 99457 and CPT 99490 in the same period.
Hospitals and physicians should take the time now to understand the financial implications of these new RPM codes and evaluate the potential for additional reimbursement opportunities for delivering Remote Patient Monitoring services. These services should be considered as part of population health, chronic care, and care coordination initiatives and seen as an opportunity to further engage patients outside of traditional care settings and the 4 walls of the clinic.
Earlier this year, we posted an article outlining the original understanding of the proposal, which can be found here.