Medicare reimbursement for Remote Patient Monitoring (RPM) should make it financially viable for a practice to adopt this technology.
RPM codes are considered Evaluation and Management (E/M) services. As such, CPT codes 99457 and 99458 can only be furnished by a physician or other qualified healthcare professional, or by clinical staff under the general supervision of the physician (eligible to bill Medicare for E/M services).
- Allowed for patients with both chronic and acute conditions
- Must be for an established patient, one with whom the physician has had a prior new patient E/M service. This E/M service is allowed to be done via telehealth.
- Monitoring must occur over at least 16 days of a 30-day period in order for CPT codes 99453 and 99454 to be billed.
- Even when multiple medical devices are provided to a patient, the services associated with all the medical devices can be billed only once per patient per 30-day period and only when at least 16 days of data have been collected. CMS also noted that CPT 99453 can be billed only once per episode of care where an episode of care is defined as “beginning when the remote physiologic monitoring service is initiated and ends with attainment of targeted treatment goals.”
Waivers During the Public Health Emergency:
- RPM can be offered to new patients.
- Remote monitoring can be reported for periods of 2 days or longer (no need for a 16-day minimum).
|Code||Description||Fac Fee||Non-Fac Fee|
|99453||Initial patient set up and education on use of equipment, can be done remotely by practice staff. (Bill only once per patient, per provider, per 30-days, and only when at least 16 days of data have been collected on at least one medical device. For CGM, use codes 95250, 95249, and 95251.)||NA||19.19|
|99454||Delivery of results/reports by practice staff to the physician caring for the patient; can be billed once every 30 days. (Bill only once per patient, per provider, per 30-days, and only when at least 16 days of data have been collected on at least one medical device. For CGM, use codes 95250, 95249, and 95251.)||69.00||63.16|
|99457||First 20 minutes of physician’s interpretation and interactive communication with the patient/care giver every month. “Interactive communication” involves, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission. (The 20 minutes includes both synchronous, real-time interactions as well as non-face-to-face care management services.)||31.75||50.94|
|99458||Subsequent 20 minutes of physician’s interpretation and interactive communication with the patient/caregiver every month. (The 20 minutes includes both synchronous, real-time interactions as well as non-face-to-face care management services.)||31.75||41.17|
|99473||Specific to self-measured blood pressure monitoring (SMBP), use this code for patient education/training and device calibration. This code can only be submitted once per device.||NA||11.52|
|99474||Specific to SMBP monitoring, submit this code once a month for ongoing treatment decisions based on the average of the patient’s SMBP readings. This code can be used when patients and/or caregivers report their BP readings back to the practice—whether it is done electronically or in person with a SMBP recording log—which then allow the physician to make ongoing treatment decisions. If 99474 services are provided on the same day the patient presents for an evaluation and management (E/M) service to the same provider, these services should be considered part of the E/M service and not reported separately.||8.72||15.00|
|99091||Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time, each 30 days. This code does not require interactive communication like 99457 to bill. However, it requires a physician or other QHP to perform these services, and requires 30 minutes of time every 30 days (not every calendar month) to bill. 99457 and 99091 cannot be billed concurrently.||56.88||56.88|
|95250||Ambulatory CGM interstitial via subcutaneous sensor for a minimum 72 hrs, office provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording. (Do not report more than once a month; do not report in conjunction with 99091, 0446T)||NA||157.37|
|95249||Ambulatory CGM ... patient provided equipment ... (Do not report more than once for the duration that the patient owns the data receiver; do not report in conjunction with 99091, 0446T)||NA||58.62|
|95251||Analysis, interpretation, and report (Do not report more than once a month; do not report in conjunction with 99091)||35.59||35.59|