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Remote Patient Monitoring
Patients with chronic medical conditions may benefit from daily non-invasive measurements of physiologic parameters, asynchronous transmission of this data to, and interpretation by, their physician to guide ongoing adjustments in the treatment plan. New technology makes this monitoring easier for both patients and physicians, and new billing options reimburse practices for their time and expenses. To help illustrate the range of RPM options available, ACP has recorded informational interviews with a sample of technology vendors, covering practical information on how physicians and patients use the technology, costs, and potential revenue. Go to Videos
Use Remote Patient Monitoring (RPM) to monitor patients between visits; examples include:
|At-home monitoring of symptoms
concerning for infectious disease
|Congestive Heart Failure||Weight|
Data reporting to physicians can be either manual (have dedicated practice staff collect readings and alert physicians when appropriate) or automated (e.g. through an electronic platform that takes in data, analyzes it and sends alerts to designated physicians when appropriate). However, CMS is proposing changes requiring automated reporting for reimbursement.
Physician communication with patient on changes in treatment plan can be in the form of phone calls or secure electronic communication such as text messages.
- ACP has recorded informational interviews with a sample of technology vendors, covering practical information on how physicians and patients use the technology, costs, and potential revenue.
- Utilize FDA-cleared devices. During the current public health emergency, devices that were originally cleared for hospital use can also be deployed in the home.
- Devices can be stand-alone, wearable, or integrated with digital interfaces like apps on a smartphone or tablet.
- Patients can record readings at home with their own FDA-cleared devices that can be acquired over-the-counter (e.g. weighing scale) or prescribed by a physician (e.g. durable medical equipment like pulse oximeters). Insurance coverage for remote patient monitoring devices varies by payer.
- Patients can deliver readings manually to their physicians (e.g. through secure email or a patient portal), or automatically through devices with Bluetooth, Wi-fi or cellular connections to electronic health records.
- New Guidance in Proposed Rule: CMS stated the RPM device should digitally (that is, automatically) upload patient physiologic data (that is, data cannot be self-recorded and/or self-reported by the patient).
Applicable Regulations and Waivers
- 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).
Billing and Coding
Medicare reimbursement for 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).
|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.*||18.77||18.77|
|99454||Delivery of results/reports by practice staff to the physician caring for the patient; can be billed once every 30 days.*||62.44||62.44|
|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.**||32.84||51.61|
|99458||Subsequent 20 minutes of physician’s interpretation and interactive communication with the patient/caregiver every month.**||32.84||42.22|
|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.||11.19||11.19|
|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.||9.02||15.16|
|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.||58.38||58.38|
In January, CMS issued a correction/clarification of language regarding the RPM codes:
* These codes can be billed only once per patient, per provider, per 30-day period, and only when at least 16 days of data have been collected on at least one medical device. NOTE: For CGM, use codes 95250, 95249, and 95251 (for more details regarding use of CGM, see the CGM module highlighted below).”
** The 20 minutes includes both synchronous, real-time interactions as well as and non-face-to-face care management services.”
Continuous Glucose Monitoring CME Module
Learn the benefits of integrating continuous glucose monitoring (CGM) into the care of your patients. You'll learn the ideal types of patients for CGM technology and receive practical tips for patient engagement. A systematic process for interpretation of CGM glycemic data is presented, along with clinical cases that allow you to apply your newly acquired knowledge to real situations. This program was funded by an unrestricted educational grant from Abbott Diabetes Care, Inc.