July 14, 2020

Medicare Reimbursement for Remote Patient Monitoring

The benefits of home care, telehealth and remote patient monitoring (RPM) are well-known. RPM, in particular, is a highly popular approach among the elderly. With RPM, they don’t need to ask for help to go out. They also can avoid the physically taxing, age-related challenge of commuting in order to get their regular checkups.

In recognition of the benefits RPM provides, the Centers for Medicare & Medicaid Services (CMS) began reimbursing for RPM services beginning 2018. However, some healthcare providers did not seem too keen to develop and roll out their RPM programs. This is mainly due to the confusion involving reimbursement.

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).

  • CPT 99453: Sets parameters on RPM involving measuring weight, blood pressure, pulse oximetry, respiratory flow rate, etc., as well as the setup and patient education regarding the use of relevant equipment.
  • CPT 99454: Sets parameters on similar items with a focus on the devices used, as well as on guidelines involving daily recordings and programmed alerts.
  • CPT 99457: Sets parameters on RPM physiologic monitoring treatment services where clinical staff, a physician or some other qualified healthcare practitioner provides professional time (initial 20 minutes) where interactive communication with the patient/caregiver is required in a calendar month.
  • CPT 99458: Sets parameters on RPM physiologic monitoring treatment services where clinical staff, a physician or some other qualified healthcare practitioner provides professional time (additional 20 minutes) where interactive communication with the patient/caregiver is required in a calendar month.

Essential billing-related information

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

  • A physician or a non-physician practitioner must have ordered the RPM. This needs to be well-documented in the patient’s medical records.
  • For CPT 99454, the device used to generate and transmit daily recording of a patient’s physiologic data or create relevant alerts must be capable of processing said data, fault-free and in good working condition.
  • For CPT 99453 and 99454, there is no assigned wRVU or any practitioner work needed to bill for such services.
  • For CPT 99457 and 99458, the practitioner or supervising physician need not be the same professional administering treatment to the patient in general. 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.

It must be noted that new patients or patients that haven’t been examined for a year need to have a face-to-face visit (e.g., annual wellness visit or physical) with their healthcare provider first.

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

Darrayl L. Miles

Vice President of Marketing