CPT® Codes for Remote Patient Monitoring (RPM)

Learn how to get reimbursed for using a tool like Propeller.

In 2018, the Centers for Medicare and Medicaid Services (CMS) unbundled and activated CPT code 99091 — for the collection and interpretation of physiologic data — to provide coverage and payment in support of remote patient monitoring (RPM) services. The same year, the American Medical Association (AMA) also developed three CPT codes related to remote monitoring, which were introduced in early 2019.

CMS formally adopted the codes in the 2019 Medicare Physician Fee Schedule. Some states have also adopted the codes in their Medicaid fee schedules, and select private payers have as well. In October 2019, the AMA developed additional RPM CPT codes. CMS released the 2020 Medicare Physician Fee Schedule in November 2019, which goes into effect on January 1, 2020. You can read the announcement from CMS related to those changes.

Remote Patient Monitoring (RPM)

The Center for Connected Health Policy defines remote patient monitoring as the use of "digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for assessment and recommendations."

"This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates."

sensor-app

Using Propeller for remote patient monitoring

  • When a Propeller user takes a dose of their controller or rescue medication, an inhaler sensor records the time, date and location, which can be used to determine environmental conditions that may be contributing to symptoms.
  • That information is synced to an app on the user’s smartphone and is uploaded to the Propeller Provider Portal.
  • The patient’s clinician can see reports about the patient’s medication usage and exacerbations and, if necessary, can follow up with the patient before their next scheduled office visit.

According to Medicare, RPM is not considered telehealth.

The reimbursement requirements for RPM are less restrictive than those for telehealth services. Under Medicare rules, telehealth services are typically reimbursable only if they are provided for beneficiaries who live in remote or medically underserved rural areas, and they require live, two-way voice and video consultations, among other restrictions.

Outside of reimbursement, the definition for telehealth varies. For example, the World Health Organization has adopted a more expansive definition of telehealth.

CPT codes for RPM

CPT code99453

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

This code offers reimbursement for the technical work associated with onboarding a new patient to an RPM service, setting up the equipment and educating the patient on using the equipment. 99453 can be billed once per episode of care.


CPT code99454

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

This code offers reimbursement for providing the patient with a device for a 30-day period. 99454 can be billed every 30 days.


CPT code99457

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

This code offers reimbursement for clinical staff time that contributes toward RPM. That time must include an interactive communication with the patient or their caregiver. 99457 can be billed every 30 days, but the 20 minutes of professional time must occur in a calendar month.


CPT code99458

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

This new code is for each additional 20 minutes of service. In November 2019, CMS announced that 99458 would be covered by Medicare beginning January 1, 2020.


CPT code99091

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

This code was unbundled and activated for payment on January 1, 2018. This code is a professional services code limited to “physicians and qualified health care professionals.” It requires at least 30 minutes of professional time dedicated to the patient per 30-day period, although it does not require “live, interactive communication with the patient or their caregiver” like 99457. It also does not require that the device be a medical device as defined by the FDA. 99457 and 99091 cannot be billed concurrently.

CODE What Who How often How much (Medicare Rate)*
99453 Initial set-up and patient education on device Not specified** Billed 1x per episode of care, minimum 16 days of monitoring $19.46
99454 Device supply with daily recordings and programmed alerts Not applicable** Billed each 30 days, minimum 16 days of monitoring $64.15
99457 First 20 minutes of monitoring and treatment management that includes interactive communication with the patient or caregiver during the calendar month; base code Performed by physician, other qualified healthcare professional (QHCP) or clinical staff Billed each 30 days

$51.54
(Non-Facility Rate)

$32.44
(Facility Rate)

99458 Each additional 20 minutes of monitoring and treatment management that includes interactive communication with the patient or caregiver during the calendar month; add-on code Performed by physician, other qualified healthcare professional (QHCP) or clinical staff Billed each 30 days

$42.22***
(Non-Facility Rate)

$32.84***
(Facility Rate)

99091 30 minutes of monitoring each 30 days that does not require interactive communication Performed by physician or other QHCP, not clinical staff Billed each 30 days $58.38

CODE 99453
What Initial set-up and patient education on device
Who Not specified**
How often Billed 1x per episode of care, minimum 16 days of monitoring
How much (Medicare Rate)* $19.46
CODE 99454
What Device suppy with daily recordings and programmed alerts
Who Not applicable**
How often Billed each 30 days, minimum 16 days of monitoring
How much (Medicare Rate)* $64.15
CODE 99457
What First 20 minutes of monitoring and treatment management that includes interactive communication with the patient or caregiver during the calendar month; base code
Who Performed by physician, other qualified healthcare professional (QHCP) or clinical staff
How often Billed each 30 days
How much (Medicare Rate)* $51.54
(Non-Facility Rate)
$32.44
(Facility Rate)

CODE 99458
What Each additional 20 minutes of monitoring and treatment management that includes interactive communication with the patient or caregiver during the calendar month; add-on code
Who Performed by physician, other qualified healthcare professional (QHCP) or clinical staff
How often Billed each 30 days
How much (Medicare Rate)* $42.22***
(Non-Facility Rate)
$32.84***
(Facility Rate)

CODE 99091
What 30 minutes of monitoring each 30 days that does not require interactive communication
Who Performed by physician or other QHCP, not clinical staff
How often Billed each 30 days
How much (Medicare Rate)* $58.38

*Centers for Medicare & Medicaid Services, revisions to payment policies under the Medicare Physician Fee Schedule, quality payment program and other revisions to Part B for CY 2019, CMS-1693-F Final Rule, updated November 2, 2018, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F.html.

**Under Medicare, CPT codes 99453 and 99454 are both practice-expense-only codes. Practice expense is the portion of the resources used in furnishing a service that reflects the general categories of physician and practitioner expenses, such as office rent and personnel wages. There is no physician time or work built into these codes.

***Values have been calculated based on valuations and RVU’s provided by Medicare in the Federal Register (https://federalregister.gov/d/2019-24086). Official values not yet released.

RPM Reimbursement and Outcomes

Key steps when coding for Propeller

Reimbursement can offset staff time to help support patient care

*Based upon Medicare non-facility rates from 2019 Physician Fee Schedule.
**This is a hypothetical scenario. Results will vary based on actual practice. Salary information sourced from Glassdoor (August 2019)

RPM programs are proven to improve health outcomes for patients

less rescue inhaler use1
reduction in COPD-related healthcare utilization2
reduction in asthma-related healthcare utilization3

1 Barrett et al. (2018). Health Affairs
2 Alshabani et al. (2019). J. Telemedicine and Telecare
3 Merchant et al., (2018), WAOJ.

Disclaimer: The reimbursement information is being provided on an “as is” basis with no express or implied warranty of any kind and should be used solely for your internal informational purposes only. The information does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. Propeller Health does not represent or warrant that any of the information being provided is true or correct and you agree to hold Propeller Health harmless in the event of any loss, damage, liabilities or claims arising from the use of the reimbursement information provided to you. Before filing any claims, it is the provider’s sole responsibility to verify current requirements and policies with the applicable payer.

Frequently Asked Questions

What types of technology can be used to deliver RPM services?

The AMA and CMS didn’t specify the types of technology — software applications, smartphones, etc. — required in the CMS-1693-F final rule. However, 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.

Does the healthcare provider need to provide the medical device in-office to bill for 99453?

No, the actual device does not need to be provided or installed in the office to qualify for reimbursement under 99453. The provider can arrange for a third-party provisioner to send the device to the patient.

However, code 99453 requires “initial set-up and patient education on the use of equipment.” So simply providing written information about the existence of a service or device would not qualify for reimbursement for that code.

Do codes 99457 and 99458 require 20 or more minutes of “interactive communication” with the patient or their caregiver in a given month?

No. The physician, qualified healthcare professional (QHCP) or clinical staff must spend at least 20 minutes of time dedicated to treatment managment services during the month, including at least one communication with the patient or their caregiver. The physician, QHCP or staff member must document their time.

Are there reduced Medicare reimbursement rates if the provider performing the services is a qualified healthcare professional and not a physician?

In cases where it’s permissible, if the service is ordered and billed directly by a QHCP and not by a physician, CMS payment policy is to reimburse at 85% of the Medicare Physician Fee Schedule (MPFS) National Payment Amount.

However, if a physician orders and bills the service under their National Provider Identifier (NPI) but uses a QHCP or clinical staff to perform the service, they would be reimbursed at 100% of the MPFS National Payment Amount.

Is there coinsurance for RPM services performed on Medicare patients?

As with all services provided under Medicare rules, Medicare patients are responsible for cost sharing — deductibles, 20% coinsurance and copayments — for RPM services.

We recently hosted a webinar and Q&A on RPM reimbursement.

jarrin-headshot Webinar Host Robert Jarrin

Strategic Advisor to ResMed and Propeller Health

(member of the American Medical Association's Digital Medical Payment Advisory Group)

Watch a recording of the webinar here
clinician-circle

To learn more about incorporating Propeller into your practice, contact us at [email protected]

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