There are two aspects of remote patient monitoring. First, it helps providers take a preventive approach rather than reactive with early detection of potential health issues. Second, when applied and billed accurately, it acts as an added revenue stream, enabling practices to experience greater financial success.
However, like any other program, providers must understand it properly to ensure rightful reimbursements. Thus, this guide will explain the major RPM CPT codes in detail, from device supply and setup to remote physiological services and remote evaluation and management. We will also discuss the RPM billing guidelines.
What are Essential RPM CPT Codes?
Here’s a list of the most important remote patient monitoring CPT codes:
CPT Codes for RPM Device Supply and Setup
CPT Code 99453 – Initial Device Setup and Training
The healthcare provider may report RPM CPT code 99453 when a patient with a chronic disease enrolls in the program. It covers the initial setup of the equipment, which may include a weighing scale, pulse oximeter, and blood pressure monitor.
Besides, the practitioner trains the patient on using these devices, transmitting data, and the course of action to take in an emergency. The role of this service is to set the foundation for remote patient monitoring by equipping patients with the necessary equipment and training them on how to use it effectively.
The typical Medicare reimbursement rate for this RPM CPT code is $19.19.
CPT Code 99454 – Device Supply and Data Retrieval
When the patient enrolls in the program, devices are often required to track and monitor the vitals. Thus, this RPM CPT code covers the supply of remote physiological monitoring equipment to patients and the retrieval of programmed alerts or recordings. Physicians can bill this code every 30 days for equipment supply and data recordings.
It enables the provider to monitor patient health metrics effectively by supplying and maintaining the necessary remote devices. The reporting physician may receive up to $63.16 against this CPT code.
RPM CPT Codes for Remote Physiological Monitoring Services
CPT Code 99457 – Remote Physiological Monitoring
Clinicians may monitor programmed alerts or remote physiological readings. For example, the provider manages a congestive heart failure patient by monitoring vitals such as the heart rate, blood rate, and weight via remote equipment. The data is reviewed and analyzed for trends, and the treatment plan is adjusted accordingly.
Besides, the provider communicates the findings and changes in the treatment plan to the caregiver or patient. Physicians may report 99457 RPM CPT code to bill these services for the first 20 minutes of the time spent to get paid up to $50.94.
It aims to provide proactive care to chronic patients by remotely monitoring vital signs, analyzing readings, and adjusting treatment plans to help treat patient’s specific conditions.
CPT Code 99458 – Additional Physiological Monitoring
It is an add-on remote patient monitoring CPT code for 99457. Providers can use it to report each additional 20 minutes spent on managing a patient’s vitals, updating the treatment plan, and interacting with the caregiver or patient.
Some patients with complex conditions require the provider to spend more time monitoring and analyzing data. Thus, this CPT code reimburses for the extra time at a rate of $41.17 for each additional 20 minutes.
Remote Patient Monitoring CPT Codes Specific to SMBP
CPT Code 99473 – SMBP Device Calibration and Education
It is specific to self-measured blood pressure (SMBP) monitoring. Physicians can bill the 99473 remote patient monitoring CPT code to indicate the calibration of the blood pressure monitoring device to ensure clinical accuracy and to guide patients or caregivers on how to use it.
It ensures patient adherence to monitoring protocols and accurate blood pressure measurements at a reimbursement rate of around $11.52.
CPT Code 99474 – SMBP Data Review and Treatment Management
Like 99473, this RPM CPT code is also specific to SMBP. The healthcare provider makes treatment decisions by analyzing the SMBP readings. For instance, a patient takes two blood pressure readings one minute apart in a day using a validated device over a month. The clinician receives a minimum of 12 readings from the patients, takes its average, prepares a report, makes ongoing treatment decisions, and communicates it to the patient.
This CPT code was introduced to facilitate data-driven clinical decision-making based on regular blood pressure data analysis. You may receive up to $15 reimbursement upon reporting this CPT code.
RPM CPT Code for Evaluation and Management (E/M)
CPT Code 99091 – Remote Evaluation and Management
This code covers interpreting medical information, such as home glucose monitoring, blood pressure readings, and ECG records transmitted by a caregiver or patient. It requires a minimum of 30 minutes of the healthcare practitioner’s time. You can bill the 99091 RPM CPT code once every 30 days.
It enables providers to offer comprehensive remote patient care by reviewing and interpreting various readings. You may receive a $56.88 reimbursement against this CPT code.
RPM Billing Requirements
Discussed below are the billing requirements for remote patient monitoring CPT codes:
Devices Should Be FDA-approved
The employed RPM devices must comply with the FDA criteria. These may include spirometers, heart rate monitors, pulse oximeters, thermometers, blood pressure monitors, weight scales, and glucometers.
Monitoring Provider Must Have a Valid NPI
Only a healthcare provider with a valid NPI number is eligible to provide remote patient monitoring services. It can be nurse practitioners, physician assistants, physicians, clinical nurse specialists, certified nurse midwives, and pharmacists.
Claims Should Be Created Once Each Month
Remember that RPM is billable monthly, and any patient enrolled in Medicare Part B can enroll in this program and receive 80% coverage.
Comply With CMS Billing Requirements
When billing for RPM services, ensure you meet the CMS requirements, record and report the care time meticulously, submit the claim within the filing deadline, and send monthly invoices to the patient receiving the service.
Conclusion
Here’s a quick recap of the remote patient monitoring CPT codes we reviewed in this guide. It included CPT code 99453 for initial device setup and training, 99454 for device supply and data retrieval, 99457 for remote physiological monitoring, 99458 for additional physiological monitoring, and 99091 for remote evaluation and management. Besides, we explained a couple of SMBP-specific codes, such as 99473 for SMBP device calibration and education and 99474 for SMBP data review and treatment management.
Moreover, we explained the RPM billing guidelines to help you maximize your reimbursements. If you want professional help, at MediBill MD, we offer tailored RPM billing services to help practices benefit from this program.
