Remote Patient Monitoring CMS CPT Codes and Guidelines

Digital health technologies are transforming healthcare, making it more affordable and accessible to people in need of professional medical supervision.

Remote Patient Monitoring (RPM) is a digital technology that monitors and collects medical health data from patients and transfers this information electronically to health specialists for examination.

RPM enables physicians to provide more patient care and supervision than ever before. Tracking analytics assist specialists in understanding what therapy patients are receiving, how they are feeling, and much more about their healthy development.

To maintain better understanding, trust, and customer experience, the Centers for Medicare & Medicaid Services (CMS) has introduced additional remote patient monitoring codes to its  Physician Fee Schedule, allowing physicians to be reimbursed for more home-based services.

Let’s move forward with the Remote Patient Monitoring CMS blog to understand everything about remote patient monitoring codes and guidelines in detail.

Remote Patient Monitoring CMS Guidelines for Reimbursement

Some suggestions from remote patient monitoring CMS Guidelines to optimize revenue, patient outcomes, and patient experience following CMS RPM reimbursement criteria.

1. Billing providers must have had at least one face-to-face interaction with the patient in 12 months.
2. Report every 30 days, regardless of the number of metrics analyzed.
3. The billing provider must be a Qualified Healthcare Professional(QHCP = MD, DO, NP, PA).
4. Suppose two staff members provide services simultaneously (for example, discussing the beneficiary’s condition). In that case, only the time spent by one professional may be counted.
5. Time less than 20 minutes in a calendar month cannot be rounded up to fulfill the billing criteria.
6. Spare time in one month cannot be carried over to the next.
7. Patients on Medicare Part B must pay a co-payment of 20%.

What are Remote Patient Monitoring CPT Codes

The Current Procedural Terminology (CPT) codes provide doctors and other health care workers with a uniform language system for classifying medical treatments to improve reporting effectiveness and precision.

CPT language is the most widely used medical terminology for reporting medical, surgical, laboratory, radiological, anesthesiology, genomic sequencing, (E/M) services covered by public and commercial health insurance systems.

Code Associated with RPM

CMS announced the final regulations for its new Remote Patient Monitoring (RPM) codes, formally named “Remote Medical Monitoring/Treatment Management,” for the Physician Fee Schedule (PFS).

CPT Code 99453 (Initial Set-Up and Monitoring)

• Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse rate, respiratory flow rate).
• Initial equipment setup and patient education on equipment use.

CPT Code 99454 (Continued Monitoring Over 16-Days)

• Vital sign monitoring (blood pressure, heart rate, weight, and so on) using an RPM device.
• Initial devices are supplied with daily recordings or programmed alerts transmission.

CPT Code 99457 (Management Services for Initial 20 Minutes)

• When clinical staff/physician/other trained healthcare professionals have to do an interactive communication with the patient/caretaker directly by audio-video call etc.
• Initial 20 minutes of duration tracking to monitor.

CPT Code 99458 (Management Services for Each Additional 20 Minutes)

• 99458 is an add-on to 99457; paid for each additional 20 minutes of RPM every month.
• Professionals cannot invoice the code in isolation; they must always use it in conjunction with 99457.

CPT Code 99091 (Collection and Evaluation of Physiologic Data)

• Data is digitally saved and communicated by the patient or caregiver to the physician or the other QHCP.
• At least 30 minutes every 30 days.

Remote Patient Monitoring CPT Codes: 3 Useful Tips on Using Them

Here are three suggestions for you to use these RPM codes appropriately and obtain further clarity:

1. Regardless of the number of devices utilized, a physician can only bill 99454 once per patient per 30 days.
2. RPM can be conducted by a billing physician, a qualified healthcare professional (QHCP), or clinical personnel under 99457. Each month, at least 20 minutes of report management time is required.
3. A practitioner can bill 99458 per month after charging 99457 for two instances: once at 40 minutes and once at 60 minutes.

Also Read: Remote Blood Pressure Monitoring: A Simple (But Complete) Guide

How Does Remote Patient Monitoring CPT Code and Billing Work?

• Remote monitoring services are available to any Medicare Part B patient.
• RPM is a monthly billable service. For Medicare to reimburse, patients must get at least 20 minutes of service each month.
• Reimbursement is also available for patients’ daily usage of RPM equipment, setup, and training.
• Data must be collected using a Health Insurance Portability and Accountability Act (HIPAA)-compliant resource, such as care management software.
• Remote physiologic monitoring services may be billed by physicians and non-physician practitioners who are eligible to provide evaluation and management services (E/M).

Billing Suggestions for Remote Patient Monitoring

When billing, you will compute the amount of time you spend with each of your patients monthly.

Before billing, you must be aware of the following:

• Each month, ensure that the CMS standards were satisfied for each patient.
• Submit claims to CMS every month.
• Check that no conflicting codes are being billed.
• Ensure that all data is wirelessly synchronized and accessible.
• Data monitoring should be undertaken by a practitioner, a competent healthcare professional, or clinical staff at a single healthcare institution.
• Estimate delivery & rental charges of devices and equipment to the patient for 16 days and how each patient will be able to opt-in to the service.

CMS Remote Patient Monitoring Reimbursement Rates Regarding the Codes

• 99453 – Initial setup of the device – $19.65
• 99454 – Monthly remote monitoring (initial 16 days) – $46.83
• 99457 – Monitoring and treatment management (least 20 min/month) – $48.14
• 99458 – Each additional 20 minutes of monitoring – $38.64
• 99091 – Interpret and process monitoring data – $52.71

Determine the ROI of a Remote Patient Monitoring CMS Program?

The healthcare industry is complex, with each organization differing greatly in operational processes, geographic characteristics, caregiver pools, and patient demographics.

It is essential to cooperate with your RPM partner to set your specific ROI targets and which of your patient demographics will best match the RPM model to determine what sort of ROI you can expect.

Consider the following inquiries:

• What kind of groups do you care about? (Which are the most expensive? Which is the riskiest?)
• What part of your process needs improvement?
• How well do you know the strengths and weaknesses of your current care continuum?

FAQs Related to Remote Patient Monitoring CMS Guidelines & CPT Code

Who has the authority to order and bill for RPM services?

Only physicians or non-physician practitioners authorized to charge Medicare for evaluation and management (E/M) services can order and bill RPM.

Who has the authority to provide RPM and seek consent?

CPT codes 99457 and 99458 may be supplied by a physician or other certified healthcare professional and clinical personnel operating under the physician’s overall direction.

Do patients get charged with co-pays for Remote Patient Monitoring CMS codes?

In most cases, yes. Patients are responsible for applicable co-pays based on the service received, as with all Medicare treatments. However, during the COVID PHE, clinicians can waive RPM co-pays.

Is consent necessary to supply and bill for RPM?

Before or at the start of the service, the practitioner must get the beneficiary’s agreement to receive RPM. This permission must admit that the beneficiary is liable for any copayments or deductibles connected with the treatment. There must be a note of verbal agreement in the medical record.

Why Choose HealthArc’s RPM

The HealthArc RPM software platform enables physician groups to enhance outcomes for thousands of patients while generating additional revenues.

• One-stop solution for health practitioners to support and improve patient care through RPM.
• Integrates with EHR and connected devices that enable external APIs, including Bluetooth and cellular devices.
• Supports multiple conditions by offering a complete overview of patient clinical data analytics.
• Improves clinical decision support by generating patients’ specific clinical insights and comprehensive health management.
• Maintains high privacy and data security levels by ensuring that all components are HIPAA compliant.

Conclusion

RPM helps healthcare professionals improve health outcomes, lower costs, and increase efficiency, but it demands seamless and strong solutions to achieve superior patient and revenue outcomes.

Schedule a demo today to learn more about billing remote patient monitoring CMS CPT codes.