Providers, rejoice: new CPT codes for remote patient monitoring (RPM) are here!
In 2018, the AMA introduced three new CPT codes to incentivize the adoption of RPM. CMS decided to reimburse for these codes in the 2019 Medicare Physician Fee Schedule.
CPT 99091 has been around for more than a decade, but it has limitations. It can still be used, but it doesn’t offer reimbursement for setting up equipment or educating the patient on its use, it’s limited to “physicians and qualified health care professionals” rather than clinical staff and it requires at least 30 minutes of professional time dedicated to the patient per 30-day period, although it does not require “interactive communication with the patient or their caregiver” like 99457. 99457 and 99091 cannot be billed concurrently.
The new CPT codes are better suited to reimburse for the realities of current technology and staffing models. While CMS has not specified which types of technology are covered under the new CPT codes, the device used must be a medical device as defined by the FDA. The Propeller platform has been cleared as a medical device by the FDA.
Here’s a quick and easy guide to the new CPT codes and when to bill for them.
CPT code 99453: “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 onboarding 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.
CPT code 99454: “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.
CPT code 99457: “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).
CPT code 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.”
What to know: Under this existing code, CMS will reimburse for professional time dedicated to monitoring services and does not require interactive communication like 99457 to bill. However, it requires a physician or other QHP to perform these services, and requires 30 minutes of time every 30 days to bill. 99457 and 99091 cannot be billed concurrently. The average national Medicare payment for these services is $58.38.
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
These are early days for the new RPM CPT codes. Medicare Advantage plans by default will reimburse on the fee schedule set by CMS; some states and commercial payers also reimburse on them.
To learn more, watch a recording of our webinar on RPM reimbursement.
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