Over the last few years, remote patient monitoring (RPM), also referred to as remote physiologic monitoring, became one of the more lucrative Medicare care management programs. Using average 2023 RPM reimbursement rates, 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 $115,000. We can largely thank the overhaul of RPM CPT codes in 2020 for such generous reimbursement.
One of the most important steps organizations must complete to capture this reimbursement, after appropriately identifying and enrolling eligible patients in an RPM program, 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. We've also included the 2023 average Medicare reimbursement rates for the codes discussed in the guide.
Remote Patient Monitoring CPT Codes and 2023 RPM Reimbursement Rates
As of January 2023, there are essentially four key CPT codes that cover remote patient monitoring: 99453, 99454, 99457, and 99458. Their descriptions and 2023 reimbursement rates 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.
- 2023 reimbursement rate: $18.84
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
- 2023 reimbursement rate: $48.93
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
- 2023 reimbursement rate: $47.60
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
- 2023 reimbursement rate: $38.68
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, remote physiologic monitoring 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). Combining RPM with CCM as part of a broader comprehensive care management program can lead to an even more beneficial program for patients and organizations, which is discussed in this Medical Economics column by Prevounce CEO Daniel Tashnek, JD.
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.
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Disclaimer
Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.
Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.
Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.
The coding options listed here are commonly used codes and are not intended to be an all- inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.
