CPT codes for remote patient monitoring have been created by the Centers for Medicare & Medicaid Services (CMS). Proper coding of remote patient monitoring services is one of the most crucial measures practices must take to receive this reimbursement.
Physicians and practitioners can provide RPM services to acute and chronic disease patients. Only physicians or non-physician professionals entitled to charge Medicare for Evaluation/Management (E/M) services can prescribe and demand the services. These services are not diagnostic tests and they cannot be billed by an independent diagnostic testing facility because a more specific code exists to define the remote patient monitoring service. In that case, that code should be used, for example, CPT code 95250 for continuous glucose monitoring and CPT codes 99473 and 99474 for self-measured blood pressure monitoring.
Tips on Remote Patient Monitoring CPT Codes
Here are the few tips to code RPM properly:
- 99454 code is used by providers to bill patient every 30 days.
- RPM can be performed by the billing physician, qualified healthcare professional (QHCP), or clinical staff under 99457 and requires 20 minutes for logged management every month.
- A practice can add up to two instances of 99458 per month after 99457 has been billed, once at 40 minutes and once at 60 minutes.
- A provider can bill via different RPM codes during the same service period for chronic care management, transitional care management (TCM) and behavioral health integration.
CPT Code for RPM
RPM monitors patient vitals outside of the hospital to enable doctors to respond and improve patient outcomes. Here is the list of code RPM CPT codes.
99453 RPM CPT Code
Remote monitoring of physiologic variables such as weight, blood pressure, pulse oximetry, and respiratory flow rate is handled by RPM CPT Code. This code contains the initialization and patient education on utilizing linked devices and best practices for when to take measures. CPT code 99453 is a one-time billing code used when a patient first enlists in a remote monitoring programmed on the advice of a physician or qualified healthcare practitioner (QHP). When billable, CPT Code 99453 averages around $19.00.
99454 RPM CPT Code
RPM CPT Code: 99454 is used for monthly remote monitoring of physical measurements and includes delivering and installing the patient’s equipment. The gadget, once again, must be authorized by a physician or QHP. CPT Code: 99454 is billable every 30 days and reflects the costs incurred by a provider whether they contract or acquire the device for their patient. CMS clarified in 2021 that these regulations require the patient to provide at least 16 days’ worth of device readings within 30 days. The typical reimbursement for CPT Code: 99454 for technologies provided under this rule is $62.00, irrespective of the device cost.
99457 RPM CPT Code
RPM CPT Code 99454 is used for care coordination and management. This monthly billing code is for RPM patients who require 20 minutes of digital treatment from a competent healthcare professional. Regardless of the RPM patient’s symptoms, this code is chargeable once a month. This code’s average reimbursement is $52.00.
99458 RPM CPT Code
RPM CPT Code 99458 is a part of the interactive virtual care. After meeting the requirements for code 99457, healthcare organizations can bill in 20-minute intervals using this code.
What You Should Know About CPT 99091
In the early 2000s, CPT 99091 was introduced to code for remote patient monitoring. It is known as the examination and analysis of physiologic data digitally stored and forwarded by the patient to the health care professional requiring a minimum of 30 minutes, every 30 days.
Because of limits and regulations, it was not recommended to bill using CPT 99091 for a time after the revised codes indicated above were established. That was modified with the final regulation for the 2021 Medicare physician fee schedule, which allowed clinicians to begin invoicing CPT 99091 using newer codes. Furthermore, CMS indicated that whenever such complicated provider management happens, CPT 99091 can be billed every 30 days without compromising a provider’s eligibility to bill clinical staff time via CPT 99457 each month.
Furthermore, CMS stated that whenever such complex provider management occurs, CPT 99091 can be paid every 30 days without affecting a provider’s monthly ability to claim professional staff time via CPT 99457.
To know more about Remote Patient Monitoring Billing and coding and billing, including average reimbursement associated with RPM CPT code. Visit our website for further updates on RPM coding.
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