Five Primary Medicare Remote Patient Monitoring CPT Codes You Should Know

Share this post:

The knowledge of these five primary CPT codes (99453, 99454, 99457, 99458, 99091) can add significant revenues to medical practice, especially when many patients are reluctant to participate in in-person care.
doctors using rpm to increase revenues
Table of Contents

The Centers for Medicare and Medicaid Services (CMS) issued its final rule concerning remote patient monitoring (RPM) reimbursement under the Medicare program on December 1, 2020. The changes are aimed to clarify CMS’ position on how it interprets requirements for RPM services. This rule finalizes many of the proposals released in August 2020.

Moreover, on January 19, 2021, CMS issued a correction revising its preamble commentary in the 2021 Physician Fee Schedule Final Rule.[1] Here are the CMS policies in the 2021 Final Rule and the revisions made.

Definition of Remote Patient Monitoring (RPM)

RPM uses digital technologies to provide patient-generated health data such as blood pressure, weight, heart rate, blood oxygen saturation (sPO2), etc. Healthcare providers can view these to analyze and treat if needed. It is a subset of telehealth and gained popularity around 2017 to 2019 before the pandemic began. However, RPM utilization skyrocketed during the health crisis as the need to monitor COVID-19 patients while decreasing possible exposure. Therefore, RPM is the best fit without compromising patient care.

According to the Center of Connected Health Policy, RPM[2] moves beyond being a simple physiologic monitoring device to reduce hospitalizations, readmissions, and length of hospital stay. In addition, RPM augmented the continuous care for chronic patients during the pandemic to lessen life-threatening symptoms and improve overall general wellbeing and health satisfaction.

There are five primary Medicare RPM codes relevant to the RPM program:

1. CPT Code 99453

99453 refers to the initial set-up of RPM devices. It also includes patient education on the use of RPM devices for their condition. This CPT code is billed only once regardless of the number of RPM devices a patient uses or the number of providers caring for the patient.

2. CPT Code 99454

99454 refers to the transmission of vital sign monitoring (blood pressure, heart rate, weight, etc.) with an RPM device. Aside from the device classified under FDA’s classification system, the device must be ordered by a healthcare provider and filed once every 30 days.

3. CPT Code 99457

99457 refers to monthly reimbursement for time spent doing at least 20 minutes reviewing patient records, including live communication with the patient by physicians thru phone or video call, analyzing data, and managing devices.

4. CPT Code 99458

99458 is a supplement to 99457 and can be billed for each additional 20 minutes for RPM per month. This code cannot be billed as a standalone code and must always be used in conjunction with 99457.

5. CPT Code 99091

99091 is for collecting and interpreting physiologic data digitally stored and/or transmitted to the physician or other QHCP by the patient and/or caregiver. It can also be billed monthly, but the requirements are more regulated than for 99457 and 99458.

Knowledge of these CPT codes can add significant revenues to medical practice, especially when many patients are reluctant to participate in in-person care. More in-depth information about CPT codes 99453 and 99454 can be found in this article.

Furthermore, CMS reaffirmed[3] the following in the final rule 2021:

1. Using RPM with new and established patients

CMS stated that a physician who has an established relationship with a patient would have had an opportunity to provide a new patient evaluation & management (E/M) service. During that new patient E/M service, the physician gathered pertinent patient history and performed a physical exam, if necessary. As a result, the physician would have the information needed to understand the patient’s current medical status and needs before ordering RPM services to collect and analyze physiologic data and develop a treatment plan.

2. Time spent on ‘interactive communication’ with a patient

CMS clarified that an “interactive communication” for CPT codes 99457 and 99458 is a real-time conversation that includes synchronous, two-way interactions that can be enhanced with video or other types of data. Therefore, the 20-minute time required to bill for CPT codes 99457 and 99458 services can include time spent furnishing care management services and the required synchronous, real-time interactions with the patient.

CMS clarified that while “interactive communication” contributes to total time, it is not the only activity included when calculating the 20-minute per month provision. In other words, the 20-minutes of work associated with CPT codes 99457 and 99458 include time spent by a practitioner on “interactive communication” as well as time spent on non-face-to-face care management services during the month.

3. RPM billing by one practitioner, per patient, per period

Only one practitioner can bill medically necessary services associated with all medical devices for a single patient, once per patient per 30-day period, and only after at least 16 days of data collection. This means that only one health practitioner can bill CPT codes 99453 and 99454 within 30 days and only when at least 16 days of data on at least one medical device has been collected. “Even when multiple medical devices are provided to a patient,” CMS explained, “only one practitioner can bill the services associated with all the medical devices, once per patient, once per 30-day period, and only when at least 16 days of data have been collected.”

Takeaway

In the post-COVID world, the success of remote patient monitoring will not be possible without the providers preserving patient relationships to extend care solutions and improve their overall health outcomes. Devices need not be inexpensive to drive revenue. Instead, adding clinical value with data analyzed to optimize services, giving patients better feedback on their conditions, and helping them with medication adherence is the best way to provide better care and outcomes.

References:

  1. PFS Final Rule – CMS. (n.d.). Retrieved from https://www.cms.gov/files/document/12120-pfs-final-rule.pdf
  2. What is telehealth? CCHP. (2021, April 16). Retrieved from https://www.cchpca.org/what-is-telehealth/?category=remote-patient-monitoring
  3. Fact sheet final policy, payment, and quality provisions changes to the Medicare physician fee schedule for calendar year 2021. CMS. (n.d.). Retrieved from https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

Share this post:

Revolutionize your healthcare with real-time

Remote Patient Monitoring

and elevate patient outcomes today.

Related Posts

independence day 2023
happy flag day 2023
On this Flag Day, we salute the spirit of our great nation! 🎉 As we embrace unity and freedom, let us honor the symbol that represents our shared values. Happy Flag Day! 🎆✨ #FlagDay #ProudAmerican #DrKumo #RemotePatientMonitoring
remembering d-day 2023
memorial day 2023

Memorial Day: A Day of Gratitude and Honor
Today, we pause to remember and express our heartfelt gratitude to our Veterans. Their service to our nation is beyond compare, and their loved ones’ sacrifices are immeasurable. We recall the words of Ronald Reagan, “Their lives remind us that freedom is not bought cheaply. It has a cost; it imposes a burden.” We take immense pride in having the privilege of serving you, and on this day, we salute you. Thank you, Veterans, and their families for your service and sacrifices.

Free Initial Consultation

Get a free 30-45 minutes consultation with one of our DrKumo RPM experts to learn everything you need to know about Remote Patient Monitoring and how you can make your RPM program successful.

To start please fill out the form and we will get in touch with you shortly.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.