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    Medicare Reimbursement for Remote Patient Monitoring

    Medicare Reimbursement for Remote Patient Monitoring

    The benefits of home care, telehealth and Remote Patient Monitoring (RPM) have helped patients of all ages. However, the greatest benefits are seen among Seniors. With RPM, Seniors  don’t need to leave their homes. There is no need to arrange transportation or experience inclement weather.  Additionally, they are able to save the cost of commuting to a doctor’s office. 

    In recognition of the benefits RPM provides, the Centers for Medicare & Medicaid Services (CMS) began, in 2018, to reimburse  medical practices and providers for RPM services.  , Initially, some healthcare providers were not excited n to develop and roll out  RPM programs. This is mainly due to the confusion involving costs and reimbursements.

    To address this, CMS issued its 2019 Physician Fee Schedule and Quality Payment Program. It refines and clarifies reimbursement terms for certain services, including the implementation of new CPT codes. These were further refined in the 2020 Medicare Physician Fee Schedule Final Rule (2020 Final Rule).

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    Essential billing-related information

    For providers to be reimbursed for RPM services, they need to meet these requirements:

    1. The RPM must be ordered by a physician or a non-physician practitioner. This needs to be well-documented in the patient’s medical records.
    2. For CPT 99454, the device used to generate and transmit daily monitoring  of a patient’s medical  data (or a device that creates relevant alerts) must be capable of processing the  data,  in a fault-free manner. It must be in good working condition.
    3. For CPT 99453 and 99454, there does not need  assigned wRVU or any practitioner work needed to bill for such services.
    4. For CPT 99457 and 99458, the practitioner or supervising physician need not be the same professional administering treatment to the patient in general. 
      1. However, CPT 99457 and 99458 need to be billed using the National Provider Identifier (NPI) of the practitioner or physician supervising the clinical staff providing the service.

    Please note, that if a patient has not been examined during a face-to-face visit for more than a year, or if it is a new patient to the doctor, then RPM is not warranted or billable. 

    Also, practitioners need to obtain their patient’s consent to provide RPM services. This should be duly reflected in their patient’s medical record.

    With these steps in place, RPM can prove highly convenient, effective, and cost-effective for both the patient and the provider.

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