Remote patient monitoring (RPM) or remote physiological monitoring gained traction in 2020 with the onset of the pandemic. Medicare was the first to cover it, and soon, Medicaid followed suit. Currently, Medicaid covers RPM in 42 states across the nation. Besides, many commercial payers within their telehealth coverage policies are covering RPM.
The Current Procedural Terminology (CPT) has separate codes for billing services related to this program. This guide will cover the remote monitoring code CPT 99454, its billing and coding requirements, and reimbursement guidelines.
So, if you want to maximize reimbursements for the RPM program and boost your revenue cycle, read this guide till the end.
99454 CPT Code – Description
CPT code 99454 covers the supply of remote physiologic monitoring devices given to the patient. It also involves receiving programmed alerts and daily readings from the patient. You can report this code once every 30 days for device supply and physiologic monitoring.
Scenarios Where CPT Code 99454 is Applicable
Here are some examples where you can report this code:
COPD Management
Assume a patient with chronic obstructive pulmonary disease (COPD) is provided a pulse oximeter and a peak flow meter for remote respiratory function monitoring. The patient records the reading at home using remote devices and transmits the data to the healthcare provider daily. Here, the physician can report CPT code 99454 for rightful reimbursements.
Hypertension Management
Another use case of CPT code 99454 is hypertension management, where consistent blood pressure monitoring is crucial. Thus, RPM can enable clinicians to assess patients’ blood pressure readings regularly by providing the necessary equipment. Besides, this data helps providers make timely adjustments to the treatment plan.
Diabetes Management
Consider a patient with type 2 diabetes. The healthcare practitioner provided a blood glucose monitor to the patient, allowing continuous tracking of the patient’s blood sugar levels in real-time throughout the day.
The timely insights into the patient’s glucose level enable the physician to make prompt decisions regarding his diet, exercise regime, and insulin doses. Here, CPT code 99454 applies.
Billing & Coding Guidelines for CPT Code 99454
Discussed below are the medical coding and billing requirements of the CPT code 99454:
Provider Eligibility
Only non-physician practitioners (NPPs) and medical professionals qualified to render evaluation and management (E/M) services are eligible to report CPT code 99454.
Patient Eligibility
All RPM-enrolled patients covered by Medicare are eligible for the remote care services covered in this CPT.
Billing Frequency
The healthcare practitioner must order the remote devices, such as digital weight scale, blood glucose monitor, pulse oximeter, blood pressure cuff, etc., to code CPT 99454 once every 30 days.
Concurrent Billing
Clinicians may bill this CPT code during the same period as Behavioral Health Integration (BHI) denoted by CPTs 99484, 99492-99494, Transitional Care Management (TCM) with CPTs 99495-99496, and Chronic Care Management (CCM) with procedural codes 99487-99490.
Data Requirements
The data should be transmitted from a remote device for a minimum of 16 days along with codes 99457 and 99458. Besides, this data should be wirelessly synced for evaluation.
The CPT 99457 reports the first 20 minutes of a physician, staff, or other qualified healthcare provider’s time spent monitoring physiological readings and interactions with a caregiver or patient for tweaking the treatment plan based on the data recordings. On the other hand, CPT 99458 is an add-on code for reporting each additional 20 minutes within 30 days.
Device Requirements
One RPM-enrolled patient can have multiple devices for remote monitoring under the CPT 99454, but the clinician can only bill these devices once per patient in 30 days. Besides, these devices must comply with the FDA standards of a medical device.
CPT Code 99454 – Reimbursement Guidelines
Discussed below are the main reimbursement guidelines associated with CPT 99454:
Reimbursement Rate
Note that rates for CPT code 99454 may vary depending on which insurance plan the patient is enrolled in and based on the specific insurance company, such as Medicare, Medicaid, or commercial payers.
However, you may receive up to $47 for reporting this code.
Documentation Requirements
You must submit comprehensive documentation with the medical claim while billing CPT 99454 for rightful reimbursements. It includes the patient’s medical history, test results, diagnosis, clinical notes, reports of patient education and training on device usage, and physiological data monitoring records for at least 16 days within 30 days.
Compliance Requirements
We recommend you stay current on RPM billing and reimbursement guidelines and adhere to the HIPAA regulations to avoid legal or financial repercussions.
Summary
Rewinding from top to bottom, what did we learn in this guide? Here’s a quick recap! We discussed the CPT code 99454 and shared some practical examples where you may apply it. These scenarios include hypertension management, COPD, and diabetes management.
Besides, we discussed billing and coding requirements related to this CPT code, including provider and patient eligibility, billing frequency, concurrent billing, and device and data requirements. We also shared the 99454 reimbursement guidelines, such as maintaining and submitting complete documentation and adhering to HIPAA rules. If you still struggle to code and bill claims, at MediBillMD, we have a team of certified professional coders (CPCs) and billing specialists to help you with tailored remote patient monitoring services.
Frequently Asked Questions
