May 11, 2021

CMS Codes Explained for Your Practice – Part Two

CPT 99091: Encouraging the Use of Remote Patient Monitoring 

Shortly before the world shut down because of COVID-19, the Centers for Medicaid and Medicare Services made a push to encourage all practices to utilize Remote Patient Monitoring.

After all, in limited use before then, using connected devices such as scales, blood pressure cuffs, and glucose meters has shown a significant reduction in hospitalization and patients truly enjoy the service.

For chronic conditions, like diabetes, hypertension or COPD, having daily measurements sent to care teams provides invaluable information to keep patients healthy.

So in 2019, the CMS added three new codes specifically aimed at encouraging Remote Patient Monitoring.

They are:

  • CPT code 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.” 
  • CPT code 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.” 
  • CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

According to the American Medical Association, they also added the following requirements:

  • Advance patient consent: practitioners must obtain advanced consent for the service and document in the patient’s record. 
  • 30-day reporting period: billing limited to once in a 30-day period. 
  • Use with other services: billing is permitted for the same service period as chronic care management (CCM) (CPT codes 99487-99490), transitional care management (TCM) (CPT codes 99495-99496), and behavioral health integration (BHI) (CPT codes 99484, 99492-99494). 
  • The Medicare program will be issuing additional guidance on the type of remote patient monitoring technology that will be permitted under 99454. 
  • CPT code 99457 and 99091 may not be billed together for the same billing period and beneficiary

We’ll go into further details about each code in later posts.

Medek RPM can make sure any practice meets all the requirements of all CMS codes. We have a team of professionals who stay on top of all the changes and work with a practice’s financial team to create the best financial return for their investment.

Plus, Medek RPM’s team of care professionals works with patients directly, keeping the providers up-to-date on patients’ health status and ensuring the best care.

To learn how Medek RPM can assist your practice and your patients, please reach out to us directly.