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 approaching $150,000.
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 July 2020, there are essentially four key CPT codes that cover remote patient monitoring: 99453, 99454, 99457, and 99458. Their descriptions are as follows:
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
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
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 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:
- A provider can only bill 99454 once per patient every 30 days regardless of the number of devices used.
- 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.
- 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.
- 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. While a practice can still code with 99091 today, doing so is no longer advisable with the availability of the four RPM codes discussed above. CPT 99091 does not offer reimbursement associated with setting up equipment or educating patients on device use. In addition, CPT 99091 does not cover clinical staff performing RPM and requires at least 30 minutes of professional time dedicated to the patient per month.
If you choose to code with 99091, note that it cannot be billed with CPT 99457 for the same billing period and beneficiary.
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.
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