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A Simple Guide to Remote Patient Monitoring CPT Codes

guide to remote patient monitoring cpt codes

Relatively new services like remote patient monitoring require CPT codes to be frequently updated.

CPT codes are created and revised through the American Medical Association to incentivize practices to implement remote patient monitoring services.

Medicare reimbursement for RPM services holds great promise for enhancing healthcare outcomes.

This article will go over the most up-to-date versions of remote patient monitoring CPT codes.

Remote Patient Monitoring CPT Codes

In November 2019, the Centers for Medicare and Medicaid Services (CMS) released the CY 2020 Physician Fee Schedule Final Rule containing updates for remote patient monitoring services.

Remote patient monitoring CPT codes include:

CPT 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.”

This is a one-time reimbursement for setting up and teaching the patient how to use remote patient monitoring device.

The 2020 national average payment amount is $20.50. Not all practices will be reimbursed the same amount for remote patient monitoring services.

CPT 99454

“Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”

This code can be billed monthly as long as the patient uses the device for at least 16 days a month.

The 2020 national payment amount is $68.21.

CPT 99457

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; initial 20 minutes

Remote patient monitoring services billed under CPT 99457 require 20 minutes of data analysis (reviewing and taking actions based on the data) per calendar month.

One of the updates (effective January 1, 2020) qualifies CPT 99457 and CPT 99458 to be carried out under the general supervision of a physician instead of direct supervision.

The CMS defines ‘general supervision’ as circumstances where “the procedure or service is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure.”

This means that some of the more general RPM services can be outsourced to third party vendors.

The current national payment amount is $35.88 (for facility) and $56.38 (for non-facility).

CPT 99458

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 is the newest RPM code. It covers each additional 20 minutes of remote patient monitoring services.

Every 20 minutes equates to 1 unit, and there is currently no limit to the number of units this code can be billed for.

Therefore, if a total of 60 minutes are spent on RPM services, clinics can bill for 2 units.

The current national payment amount is $35.88 (for facility) and $46.13 (for non-facility).

Billing Requirements for Remote Patient Monitoring

In order to bill for remote patient monitoring CPT codes:

  • Medical device must be FDA-approved
  • Patient needs to opt in for the service
  • Device must be used by the patient for at least 16 days a month
  • Data collection must be HIPAA-compliant
  • Data analysis services must be performed under general supervision of a physician

Ready to Try Remote Patient Monitoring?

Medicare recognizes that remote patient monitoring can play a significant role in the future of healthcare.

By implementing remote patient monitoring technologies into the workflow, clinicians can improve quality of care and generate more revenue.

Interested in implementing remote patient monitoring in your practice? Click here to try a free demo of Tenovi Health’s RPM devices.

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