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In 2018, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers for remote patient monitoring (RPM) after recognizing the mounting evidence that such monitoring reduces hospitalization rates, enhances care coordination, and improves patient outcomes. Since then, CMS has drastically changed the RPM billing system. It introduced three new CPT codes, streamlined the reporting and documentation requirements, allowed for clinical staff to furnish RPM under general supervision, and increased reimbursement. The vast majority of providers will benefit from using this newer billing regime. As such, it will be the focus of this guide.
Since CMS adopted RPM, other insurance providers have also begun to reimburse for the service. As of this writing, more than 20 state Medicaid programs and many private insurers reimburse for RPM, although some have different requirements compared to Medicare. The Center for Connected Health Policy publishes a semi-annual report that does a good job of outlining current non-Medicare reimbursement policies that you can find here.
CPT 99453 is used to report the setup and patient education on RPM and use of the device(s). As such, this code is generally billed once per patient on the initiation of RPM services.
CPT 99454 is the monthly code that reimburses for the supply of the device and monitoring of patient data. This code requires that patient readings be performed at least 16 days each month.
As such, for the first 20 minutes of logged management time each month a practice can bill 99457. Once 99457 has been billed, a practice can add up to two instances of 99458 at 40 minutes and 60 minutes, respectively.
As of 2020, CMS has announced that 99457 and 99458 can be furnished by clinical staff under the general supervision of the billing provider.
99453: Initial patient setup and enrollment into RPM program.
99454: Remote monitoring and management of device readings. Averages $64.
99457: 20 minutes of clinical staff time communicating with patient or caregiver. Averages $55
99458: Additional 20 minutes of clinical staff communication with patient or caregiver. Averages $44.
99458: Additional 20 minutes of clinical staff communication with patient or caregiver. Averages $44.
You bill 99453 when you first initiate RPM services on a patient. Then you bill 99454 for each month the patient transmits readings at least 16 days.
In addition to the monthly 99454, you also bill for the amount of time you spend managing the patient within the program. The first 20 minutes of such management is billed under 99457. You can then bill 99458 for each additional 20 minutes, up to a total of 60 minutes of management time.
Medicare and other insurers holds great promise for lowering hospital admission rates and improving outcomes for patients with chronic conditions or who otherwise require ongoing monitoring.
Prevounce is committed to helping both patients and practices benefit from care management services such as RPM. In addition to this guide, you can find many more questions answered in our RPM FAQ.
7401 Wiles Rd. #139 Coral Springs, FL 33067
Call us: 1 (800) 648 8831
7401 Wiles Rd. #139 Coral Springs, FL 33067
Call us: 1 (800) 648 8831
© 2022 Quest Health PRM Services
© 2022 Quest Health PRM Services