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3 FAQs about CPT 99457, 99458, and 99091

Learn how CPT codes 99457, 99458, and 99091 can help you achieve your goals in implementing a successful remote patient monitoring program.

Remote patient monitoring (RPM) programs have grown in popularity in recent years. The COVID-19 pandemic, combined with technological advancements as well as increased adoption among hospitals, care coordinators, physicians and patients, has increased demand even further. In response, the Centers for Medicare and Medicaid Services (CMS) have deployed several codes for remote monitoring service reimbursement.

The five most significant CPT codes for providers providing an RPM program are 99453, 99454, 99457, 99458, and 99091. DrKumo already listed FAQs about RPM billing and reimbursement to address providers’ frequently asked questions. In this article, we will answer more queries related to CPT 99457, 99458, and 99091.

What Healthcare Providers Should Know

What Do CPT Codes 99457, 99458, and 99091 cover?

Providers are reimbursed under the CPT codes 99457, 99458, and 99091 codes for work pertaining to remote physiologic monitoring, including medical intervention, care coordination, and patient interaction. This work is most commonly used to manage patients with chronic illnesses such as diabetes, obesity, hypertension, and heart failure, but it could also be used to treat a variety of other chronic, acute, and subacute conditions.

  • 99457 – This monthly billing code for RPM patients requires 20 minutes of interactive virtual care from a qualified healthcare provider or care manager during the calendar month. Regardless of the RPM patient’s conditions, this code is billable once a month.
  • 99458 – This code also requires interactive virtual care during the calendar month. This code, on the other hand, is for additional time spent with the patient. After meeting the requirements for code 99457, healthcare providers can bill in 20-minute increments using this code. It should be noted that 99458 cannot be billed as a stand-alone code. It must be used in conjunction with the code 99457.
  • 99091 – This code is for the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted to the physician or other qualified healthcare professional (QHP) by the patient and/or caregiver. This code requires at least 30 minutes of time every 30 days. Clinical staff time, including time spent providing care management services, cannot be counted for non-QHPs.

NOTE: When a code’s description includes time, it serves as a reminder to ensure that the provider documentation includes that component in the visit note (documented).

What to consider when billing for CPT Codes 99457, 99458, and 99091?

Clarification of the Requirement for “Interactive Communication”

CMS issued a clarification for CPT codes 99457 and 99458 in late 2020, stating that an ‘interactive communication’ may be an audio conversation that takes place in real-time and includes synchronous, two-way interaction that can be enhanced with video or other types of data. CMS also clarified that the interactive communication did not have to count as the entire 20-minutes required to bill 99457 and 99458 and could include time spent providing care management services in addition to the required interactive communication.[1]

Definition of Qualified Healthcare Professional vs Clinical Staff

CPT code 99091 refers to time spent by a physician or other qualified health care provider on remote patient monitoring services. Non-QHPs cannot claim time spent by clinical staff, even if they are providing care management services.

A qualified healthcare professional (QHP), according to the American Medical Association (AMA), is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable), and who performs a professional service within his/her scope of practice and independently reports that professional service.[2]

Average National Medicare Payment Amount for 99457, 99458, and 99091

The general national payment amount under the 2022 Medicare Physician Fee Schedule[3] is:

  • 99457: $50.18
  • 99458: $40.84
  • 99091: $56.41

It should be noted that these are average national Medicare payment amounts. Commercial reimbursement amounts, on the other hand, can differ – some are higher, while others are lower. To get a more accurate sense of exact reimbursement rates for any given geographic region, consult with local payer representatives or a local Medicare Administrative Contractor (MAC).[4]

What are the best practices for utilizing CPT Codes 99457, 99458, and 99091?

Choose the right RPM partner

There are numerous aspects to consider when choosing the best Remote Patient Monitoring partner, such as technology platform, features, integration specifications, cost, security, and credibility. Working with the right organization can help you not only meet, but also exceed, your clinical objectives. Make sure that your RPM partner provides continuous support from delivering the highest level of care for your patients to billing and reimbursement.

Aim for high patient engagement and adherence

A successful RPM program requires patient engagement and adherence. If patients do not participate in the program, they may not take regular measurements correctly according to their treatment plan schedule, reducing the clinical efficacy of remote monitoring and your eligibility to bill for the service. To achieve high patient engagement, make sure your RPM partner’s technology solution was designed to allow patients to use technology easily regardless of their level of technological literacy, provides alerts that remind patients to take measurements and comply with the treatment plan, providers easy to understand manuals and patient education systems available in multiple languages.

DrKumo Inc. provides billing and reimbursement support for healthcare providers who want to deploy Remote Patient Monitoring program. Contact us for more information.

References:

  1. Final Policy, Payment, And Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS. (2020, December 1). Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 | CMS. https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1.
  2. Derricks, J. (2015, January 1). Define a Qualified Healthcare Professional – AAPC Knowledge Center. AAPC Knowledge Center. https://www.aapc.com/blog/28964-define-a-qualified-healthcare-professional/.
  3. Physician Fee Schedule | CMS. (2021, December 1). Physician Fee Schedule | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched.
  4. What’s a mac. CMS. (n.d.). Retrieved from https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/What-is-a-MAC

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