As telehealth and remote patient monitoring (RPM) become a crucial part of many healthcare organizations’ practices, getting accurately reimbursed for these services is essential.
The reimbursement process is based on Current Procedural Terminology (CPT) codes, which categorize and specify billing rates for procedures, treatments, and care services. Understanding what these codes mean for your RPM program will help you project revenue and optimize your staff’s capacity.
CPT Code 99453
What You Need to Know About Remote Patient Monitoring CPT Codes
Billing for Remote Patient Monitoring, or RPM, is based on Current Procedural Terminology (CPT), which is the system that determines how much reimbursement can be awarded and who receives it. Knowing how to read these codes can help ensure your clients get the correct care and services they need while also helping optimize your medical staff’s working capacity.
The main CPT for RPM is 99453, which reimburses a physician or a qualified healthcare professional for the time it takes to set up devices and educate patients on using them. This can take up to an unspecified amount of time but is essential for patients who are new to their monitors and need help learning how to use them.
CPT Code 99454
What You Need to Know About Remote Patient Monitoring CPT Codes for Billing
Healthcare providers use specialized codes to remote patient monitoring billing services. These codes define procedural rules and billing rates for various tasks and services.
The most critical RPM code for billing is CPT 99454, which reimburses providers for monthly remote monitoring. This service involves the supply and use of medical devices to remotely monitor the physiologic parameters of patients for a minimum of 16 days.
CPT Code 99457
What You Need to Know About Remote Patient Monitoring CPT Codes for Billing
The Centers for Medicare and Medicaid Services (CMS) has added several new codes to help family medicine providers implement and scale remote patient monitoring programs.
Additionally, these remote patient monitoring companies codes offer financial reimbursement for device setup, equipment supply, and ongoing monitoring.
However, a key consideration for medical coders is how much time a physician or other qualified healthcare professional (QHCP) can spend providing these services to get reimbursed.
According to the 2021 Physician Fee Schedule Final Rule, physicians and QHCPs must spend at least 20 minutes per calendar month interpreting remotely monitored physiologic data. That includes medical decision-making and communication with patients via synchronous two-way audio interaction, as well as oversight of the management and coordination of the service.
CPT Code 99458
What You Need to Know About Remote Patient Monitoring CPT Codes
Billing for medical services is based on Current Procedural Terminology (CPT) codes. These codes outline the eligible benefits for reimbursement, how often they can be billed, and which entities can receive those payments.
This is why physicians and physician practices must understand the ins and outs of these codes. CMS has clarified RPM-related regulations in the past couple of years, so it is essential to understand these changes.
For example, with CPT Code 99457, physicians and physician practices can be reimbursed for their time providing care management services to patients through RPM. Recent clarifications have indicated that this time is not limited to ‘interactive communication’ with the patient; it can include the entire process of providing care management services remotely.
CPT Code 99091
What You Need to Know About Remote Patient Monitoring CPT Codes
In 2018, CMS changed how it reimburses healthcare providers for remotely collecting and interpreting physiologic data. This changed the way that providers could bill Medicare for their RPM services.
The new code is CPT Code 99091. It pays for collecting and interpreting physiologic information digitally stored or transmitted by a patient to a physician or other qualified healthcare professional (QHCP).
The first 20 minutes spent on remote patient monitoring services, or “interactive communication with the patient” in a calendar month, can be billed under this code. A corollary code, 99458, allows for any additional 20-minute intervals of interactive communication per calendar month.
