Your guide to the new CPT codes for remote patient monitoring (RPM)

Providers, rejoice: new CPT codes for remote patient monitoring (RPM) are here!

In 2018, the AMA introduced three new remote patient monitoring CPT codes to incentivize the adoption of remote patient monitoring. CMS decided to reimburse for the new codes in the 2019 Medicare Physician Fee Schedule.

CPT 99091 has been around for more than a decade, but it has limitations. 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 interactive communication per 30-day period.

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 code descriptions provide some guidance (e.g., weight trackers, blood pressure trackers, pulse oximetry trackers and respiratory flow rate trackers).

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 remote patient monitoring 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: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; 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 device and monitoring the data obtained 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 remote patient monitoring. In addition, the time frame required has been reduced from 30 minutes of interactive communication per 30-day period to 20 minutes per month. Both changes should make it easier to bring RPM services to patients. The average national Medicare payment for these services is $51.54 (non-facility) and $32.44 (facility).

To bill on these codes, you’ll need to check the following boxes:

  • The patient must opt-in for the service
  • Devices must meet the FDA’s definition of medical device
  • Monitoring must take place 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 remote patient monitoring CPT codes. Medicare Advantage plans by default will reimburse on the fee schedule set by CMS, but we’re still waiting to see if and when Medicaid and commercial payers will reimburse on them.

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