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Remote Patient Monitoring

CPT 99091 was introduced in 2002 to describe remote patient monitoring, however the code had to be attached with other services codes to indicate RPM services provided. CPT 99091 eventually evolved to include reimbursement of $58. CPT 99091 is defined as “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 health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”

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“Remote monitoring of physiologic parameter(s) (e.g, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”

What to know:

CPT 99453 offers reimbursement for the work associated with on boarding a new patient onto a RPM service, setting up the equipment and educating the patient on using the equipment. The average national Medicare payment for these services is $19.46.

“Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”

What to know:

CPT 99454 offers reimbursement for providing the patient with a RPM device for a 30-day period. Note that 99454 can be billed each 30 days. The average national Medicare payment for these services is $64.15.

“Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

What to know:

Under this new code, CMS will reimburse for clinical staff time that contributes toward monitoring and interactive communication which includes phone, text and email. The average national Medicare payment for these services is $51.54 (non-facility) and $32.44 (facility).

Understanding the Difference Between Remote Patient Monitoring and Chronic Care Management

Chronic care management (CCM), initiated in 2015, by the Centers for Medicare and Medicaid Services (CMS)to open opportunities in telehealth services is nearing the end of its third year. Yet,many Providers have opted not to provide CCM services – the reporting requirements and eligibility has been a significant barrier. Coupled with the fact that the median number of CCM patients per physician is 10, remote patient monitoring (RPM) is emerging as more attractive opportunity for Providers due to the staff requirements, reimbursement rate, patient eligibility and service flexibility. RPM has the potential to gain rapid traction where CCM could not.


Who can bill CPT Code 99457?

CPT Code 99457 allows for reimbursement for time spent by the billing physician, a qualified healthcare professional (“QHCP”), or clinical staff. All practitioners must practice in accordance with applicable state law and scope of practice laws.

What are the checks on billing of these codes?

To bill on these codes, you’ll need to check the following boxes: The patient must opt-in for the service Device must meet the FDA’s definition of medical device Device must be supplied for at least 16 days to be applied to a billing period The service must be ordered by a physician or other qualified healthcare professional Data must be wirelessly synced where it can be evaluated The data-monitoring services may be performed by the physician, by a qualified healthcare professional or by clinical staff. Clinical staff may include RNs and medical assistants, depending on state law

How much time is required to bill CPT Code 99457?

The code requires the physician, QHCP, or clinical staff to spend at least 20 minutes per calendar month providing CCRPM services to a particular patient in order to receive reimbursement.

Can CPT Code 99457 be billed “Incident To”?

The Rule states that CPT Code 99457 describes only professional time and “therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services.” This position is in stark contrast to CMS’s current stance on traditional Chronic Care Management (CCM) services, whereby CMS has not only allowed the services to be billed “incident to,” but has also allowed the incident to services to be performed under general supervision rather than the more strict direct supervision as is typically required for incident to billing. This position also appears to contradict the descriptor of the code itself, which states the services can be furnished by clinical staff. It is unclear why CMS has taken this new position, but for now, practitioners should refrain from billing CPT Code 99457 when furnished incident to their professional services.

Can I receive reimbursement for supplying the device and educating the patient?

Yes. CPT Code 99453 provides reimbursement for initial set-up and patient education on how to use the monitoring equipment, and CPT Code 99454 provides reimbursement for supplying the device. Note that 99454 can be billed each 30 days.

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