The Centers for Medicare and Medicaid Services (CMS) made significant changes to its CPT codes to incentivize more clinics to employ remote patient monitoring. CPT codes are used in the medical sector to bill clients for healthcare services. For RPM, this refers to billing clients for remotely monitoring their health and providing healthcare services. CPT codes are used to bill the Centers for Medicare and Medicaid Services (CMS), resulting in a revenue model for small and medium-sized medical care providers. More information can be found in our FAQ on billing and reimbursement.
There are essentially four important CPT codes that support remote patient monitoring as of July 2020: 99453, 99454, 99457, and 99458. Their descriptions are as follows:
CPT Code 99453
Healthcare providers may get reimbursement for the onboarding and education of patients as this CPT code covers the one-time cost that providers can charge for enrolling the patient into the new remote patient monitoring (RPM) system. This CPT code includes the time they spent setting up the system, educating the patient how to operate the system or the medical device(s), and any other services that come along with this. Note: CMS does not reimburse for the equipment but just the time spent with the initial set-up. This code was designed to assist patients on the usage of devices and compensate clinicians in training them.
CPT Code 99454
This CPT code allows healthcare providers to bill monthly or every 30 days. It is a code for the cost of leasing home health medical device to the patient and the software or mobile application used to run this RPM service. The device should not be previously owned by the patient but instead should be provided by the healthcare professional. The device must only be used for home care and needs to automatically upload the data to the provider daily. CMS provided clarification that this code requires the patient to submit at least 16 days of device readings during the 30-day period. A patient may have multiple RPM devices, but healthcare providers can only bill once per patient per 30-day period, and only when at least 16 days of patient-generated data has been transmitted, even when many devices are given to one patient.
CPT Code 99457
This code refers to RPM care management services spent with a minimum of 20-minute duration in one calendar month by a healthcare provider— could be a physician, clinical staff, or a qualified healthcare professional. (Clinical staff includes but is not limited to registered nurses or medical assistants; subject to the scope of the state law and practice, and the supervision requirements included in the applicable law.)
This reimbursement covers for clinical staff time used for monitoring a patient’s health data and interactive communication with a patient through phone, text or email. Example of patient’s health data – blood pressure, glucose level, pulse rate, and weight. This code is billable once per month regardless of the patient’s conditions.
CPT Code 99458
This is an add-on to the CPT code 99457, a part of interactive virtual care and monitoring, stating that healthcare providers can be reimbursed for every additional 20 minutes every month. CPT Code 99458 is for additional time spent with the patient. It means, 99458 cannot be billed as a standalone code. It must be billed in conjunction with 99457. Healthcare providers may additionally bill in 20-minute increments using this code after they meet the requirements for code 99457. For instance, if a doctor spends 40 minutes of virtual care covered by RPM, this code will be used to bill for the incremental 20 minutes.
Medicare acknowledges that Remote Patient Monitoring (RPM) has the pivotal role in the future of healthcare. Clinicians can improve care quality and generate more revenue by incorporating remote patient monitoring technologies into their workflow. Find more information about RPM in our quick FAQ article.
DrKumo provides healthcare providers with smooth Remote Patient Monitoring Billing and Reimbursement assistance. Contact us to know more information.