Quick Guide: Remote Patient Monitoring CPT Codes to Know

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by Lucy Lamboley

Updated for 2022

Thanks to an overhaul of CPT codes in 2020, remote patient monitoring (RPM) became one of the more lucrative Medicare care management programs essentially overnight. If 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, that will generate annual reimbursement exceeding $100,000.

One of the most important steps practices must complete to capture this reimbursement is proper coding of their remote patient monitoring services. This Prevounce Quick Guide outlines the current remote patient monitoring CPT codes and shares some tips for proper RPM coding.

Remote Patient Monitoring CPT Codes

As of January 2022, there are essentially four key CPT codes that cover remote patient monitoring: 99453, 99454, 99457, and 99458. Their descriptions are as follows:

CPT 99453

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

CPT 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

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

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

Remote Patient Monitoring CPT Codes: 4 Tips

Here are four tips to help ensure you use these RPM codes properly:

  1. A provider can only bill 99454 once per patient every 30 days regardless of the number of devices used.
  2. Under 99457, RPM can be performed by the billing physician, qualified healthcare professional (QHCP), or clinical staff. It requires at least 20 minutes of logged management time each month.
  3. Once 99457 has been billed, a practice can add up to two instances of 99458 per month: once at 40 minutes and once at 60 minutes.
  4. A provider can bill via these RPM codes during the same service period as chronic care management (CCM) (via CPT codes 99487-99490), transitional care management (TCM) (via CPT codes 99495-99496), and behavioral health integration (BHI) (via CPT codes 99484, 99492-99494).

What to Know About CPT 99091

CPT 99091 was created in the early 2000s to code for remote patient monitoring. Its descriptor: "Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days."

For a period after the newer codes discussed above were introduced, it was not advisable to bill using CPT 99091 because of limitations and requirements. However, that changed with the 2021 Medicare physician fee schedule final rule that permitted providers to begin billing CPT 99091 with newer codes. Federal rules now allow providers to bill for "complex" RPM management when they are required to spend substantial time managing the patient and their remote patient monitoring care plan. 

Furthermore, CMS stated that CPT 99091 can be billed each 30 days whenever such complex provider management occurs and without affecting a provider's ability to bill clinical staff time via CPT 99457 each month. 

Learn More About Remote Patient Monitoring Coding and Billing

We hope you found this Prevounce Quick Guide helpful. To learn more about RPM coding and billing, including average reimbursement associated with the RPM CPT coding, we recommend that you download our Remote Patient Monitoring Billing Guide. For more general information on remote patient monitoring, see this comprehensive guide.

CPT Copyright 2022 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Download the Guide: A Comprehensive Guide to Remote Patient Monitoring

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