Remote Patient Monitoring

Remote Patient Monitoring (RPM) uses digital devices to collect patient health information in one location and electronically transmit that information securely to a provider in a different location. The demand for RPM services has been rapidly rising and seems like it is here to stay. This means that billing for remote patient monitoring is witnessing significant changes to adapt to RPM’s increasing prevalence. Many healthcare providers are facing challenges when it comes to their remote patient monitoring billing and reimbursement for the services rendered.

3Gen Consulting is dedicated to helping providers optimize their remote patient monitoring billing and collections process, dramatically reduce time and resources spent on revenue cycle management and achieve financial goals. Our RPM billing solutions are efficient, cost-effective and scalable to meet each provider’s growing and unique needs.

Remote Patient Monitoring Billing Codes

Recognizing the significant advantages associated with remote patient monitoring services, Current Procedural Terminology (CPT) codes have been introduced for RPM billing purposes and insurance reimbursement. Incorrect use of codes can result in payment recoupments or even denials. It is important to note that RPM services are covered when provided by the physician, qualified healthcare professional, or clinical staff.

Knowledge of the following five remote patient monitoring billing codes can add significant revenue to a healthcare provider:

  • Service Initiation – CPT 99453
    Remote monitoring of physiologic parameter(s) (e.g. weight, blood pressure, pulse oximetry, respiratory flow rate), plus initial set-up and patient education on use of equipment. Initial set-up and patient education of monitoring equipment included; do not report 99453 for monitoring of less than 16 days.
  • Data Transmission – CPT 99454
    Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. Initial collection, transmission, and report/summary services to the clinician managing the patient.
  • Treatment Management Services (1) – CPT 99457
    Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month, requiring interactive communication with the patient/caregiver during the month; first 20 minutes.
  • Treatment Management Services (2) – CPT 99458
    Each additional 20 minutes. List separately in addition to code for primary procedure.
  • Data Analysis & Interpretation – CPT 99091
    Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring), digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.

Frequently Asked Questions

RPM can be ordered and billed only by physicians or non-physician practitioners who are eligible to bill Medicare for Evaluation and Management (E/M) services.

In the 2021 Final Rule, CMS clarified that an “interactive communication” for CPT codes 99457 and 99458 requires, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.

For CPT codes 99457 and 99458, the 20-minutes of time required to bill services 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.

To bill for remote patient monitoring services, the practitioner must have an established relationship with the beneficiary.

According to CMS, “[t]he medically necessary services associated with all the medical devices for a single patient can be billed by only one practitioner, only once per patient per 30-day period, and only when at least 16 days of data have been collected.”

The practitioner must obtain the patient’s consent for RPM services either prior to or at the initiation of the service. Consent can be provided verbally, in writing or electronically, but must documented in the patient’s medical record. Once consent is provided, an acknowledgement that the beneficiary will be responsible for the co-payment or deductible associated with the services, should be included.

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