Top 7 FAQs About Remote Patient Monitoring (RPM) Billing and Reimbursement

Remote Patient Monitoring has become one of the fastest growing technologies in the healthcare industry due to its rapid adoption. The top seven most frequently asked questions and answers about RPM Billing and Reimbursement are listed in this article.

The COVID-19 pandemic accelerated the need to manage high-risk patients’ care outside of traditional healthcare settings, pushing providers to shift to modern and technological care delivery models. Medicare Reimbursement for Remote Patient Monitoring (RPM) became available in March 2020, making it more financially feasible to provide these services to patients. RPM has become one of the fastest growing technologies in the healthcare industry due to its rapid adoption.

Preparation, planning, and partnering with the right telehealth provider are essential for a successful RPM program. DrKumo featured 4 Things to Look for When Choosing a Telehealth Company in 2022 and Top 8 Tips for Running a Successful Remote Patient Monitoring. One of the most significant advantages of RPM for providers is the increased of revenue streams. In order to be successful, providers must choose an RPM partner who can provide smooth Medicare billing and reimbursement assistance.

The top seven most frequently asked questions and answers about remote patient monitoring are listed below:

What are the common examples of RPM devices qualified for Medicare?

Blood pressure monitors, weight scales, pulse oximeters, and blood glucose meters are some of the most common RPM devices. The health monitoring device must meet the FDA’s definition of a medical device as described in section 201(h) of the Federal, Food, Drug and Cosmetic Act. There is no language in the CPT Codebook indicating the device must be FDA-cleared, although such clearance may be appropriate. To be eligible for Medicare, the RPM device must digitally (that is, automatically) upload patient physiologic data and cannot be self-recorded or self-reported by the patient.

Should the patient have a chronic condition to qualify for RPM?

Although CMS previously defined RPM services as those provided to patients with chronic diseases in the 2019 PFS final rule, CMS clarified in the 2021 Proposed Rule that practitioners may provide RPM services to remotely collect and analyze physiologic data from both acute and chronic patients.

Who can order and bill for RPM services?

RPM codes are classified as Evaluation and Management services (E/M). They may be ordered and billed only by physicians or nonphysician practitioners who are Medicare-eligible to bill for E/M services, according to CMS.

Who can furnish RPM and obtain consent?

CPT codes 99457 and 99458 may be provided by a physician or other qualified healthcare professional, as well as by clinical staff working under the physician’s general supervision.

Can RPM be used on both new and established patients?

As stated in CMS 2021 Final Rule, RPM services are available only to “established patients.”  However, CMS asserted, in support of this position, that a physician who has an established relationship with a patient would likely have had an opportunity to provide a new patient E/M service.  During that new patient E/M service, the physician would have gathered relevant 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 prior to ordering RPM services to collect and analyze physiologic data and develop a treatment plan. CMS waived the “established patient” restriction during the Public Health Emergency (PHE), but declined to extend such waiver beyond the PHE in the 2021 Final Rule. The CMS waiver implies (but does not explicitly state) that practitioners may perform RPM services during the PHE without first performing a new patient E/M service. After the PHE waiver expires, a patient-practitioner relationship must be established in order to bill Medicare for CPT 99453, 99454, 99457, and 99458. This usually necessitates the practitioner performing a new patient E/M service.

What is the scope of “interactive communication” with the patient?

CMS clarified that 20-minutes of intra-service work associated with CPT codes 99457 and 99458 includes time spent by a practitioner on “interactive communication” as well as time spent on non-face-to-face care management services during the month.

The required 20 minutes of “interactive communication” with the patient would make RPM an outlier in comparison to other similar services, such as chronic care management services (CCM), for which CMS has stated that the time-based requirements include a combination of patient interactive communication, monitoring, and management of the patient’s care plan.

What are the primary Medicare CPT codes for RPM?

The main CPT Codes that are used for Remote Patient Monitoring are 99453, 99454, 99457, 99458.

  • CPT Code 99453: Initial equipment setup and patient education.
  • CPT Code 99454: Device or devices provided to the patient for daily monitoring or data transmission.
  • CPT Code 99457: 20 minutes of RPM care provided by clinical staff/physician/other qualified healthcare professional in a calendar month, requiring interactive communication with the patient/caregiver throughout the month (initial 20 minutes)
  • CPT Code 99458: For every additional 20 minutes (List separately.) This code can be added to 99457 after the physician has provided at least 40 minutes of care to the patient.

Click here to learn more about Remote Patient Monitoring CPT codes.

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