Remote Patient Monitoring CPT Codes – Neolytix

rpm billing

In this article, we’ll navigate through the essential CMS requirements for RPM billing, explore the CPT codes underpinning this system, and shed light on the critical role that Remote Patient Monitoring devices play in revolutionizing patient care. 

CMS requirements for RPM Billing

According The Centers for Medicare and Medicaid Services (CMS), to bill for Remote Patient Monitoring (RPM) and Chronic Care Management services, healthcare providers must adhere to specific technical criteria and documentation requirements, which include: 

1. Use a Certified Electronic Health Record (EHR) Technology

Providers should utilize certified EHR technology to track and manage RPM data. EHR systems allow for seamless integration and storage of patient information, making it accessible for both providers and patients. It also enables secure data exchange between healthcare professionals. 

2. Spend at Least 20 Minutes per Month with the Patient 

Providers are required to dedicate at least 20 minutes per month to RPM services for each patient. This time includes activities like setting up monitoring devices, reviewing data, communicating with the patient, and adjusting treatment plans based on the collected information.

3. Record 16 Days of Remote Device Readings 

To bill for RPM services, providers should record a minimum of 16 days of remote device readings per month. This entails consistent data collection and regular analysis of the information received from the monitoring devices. It’s crucial for providers to ensure that these data are accurate, up to date, and securely stored.

4. Document Time and Device Readings 

Accurate documentation is essential. Providers must maintain detailed records of the time spent on RPM activities, such as device setup, patient communication, and data analysis. Additionally, they should document the specific device readings and any significant observations or decisions made based on the collected data.

5. Compile Monthly Reports and Summary of RPM Data 

Providers are required to compile monthly reports summarizing the RPM data collected. These reports should provide an overview of the patient’s health status, any changes observed, and the treatment adjustments made. The reports must be easily accessible, organized, and available for both healthcare professionals and patients.

6. Secure Data Management 

Protecting patient data is crucial. Providers should ensure that the RPM data are securely stored in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations. This involves measures like encryption, access controls, and secure transmission of data between devices and EHR systems.

7. Billing and Coding 

Healthcare providers must use the appropriate billing codes when submitting claims for RPM services. Codes and reimbursement rates may change, so it’s important to stay updated with the latest CMS guidelines and coding updates. In the next section, we will delve into the remote patient monitoring CPT codes that underpin RPM Billing.  

Remote Patient Monitoring CPT Codes: RPM Billing

CPT Codes Reimbursement Description
99453 $19.32 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
99454 $50.15 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
99457 $48.80 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
99458 $39.65 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)
99091 $54.22 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, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days

Now let’s look at these CPT codes in action. 

remote patient monitoring cpt codes

Perhaps it’s time you consider revising the number of patients eligible for remote patient monitoring in your healthcare organization, and do the math to see what is the reimbursement potential associated with RPM. Or, take a shortcut and schedule a FREE Demo with Neolytix today.  

Remote Patient Monitoring CPT Codes: CCM Billing

Remote Patient Monitoring and Chronic Care Management collaborate to improve care and outcomes for patients diagnosed with chronic conditions. Here are the CPT Codes used in Chronic Care Management billing.  

CCM Codes Reimbursement Description
99490 $62.69 Non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability
99439 $47.44 Each additional 20 minutes of clinical staff time spent providing non-complex CCM directed by a physician or other qualified health care professional (billed in conjunction with CPT code 99490)
99487 $133.18 Complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish comprehensive care plan that involves moderate- to high-complexity medical decision making.
99489 $70.49 Each additional 30 minutes of clinical staff time spent providing complex CCM directed by a physician or other qualified health care professional (report in conjunction with CPT code 99487; cannot be billed with CPT code 99490)
99491 $85.06 CCM services provided personally by a physician or other qualified healthcare professional for at least 30 minutes.
99437 $59.98  Add-on code for 99491 and is billed to patients receiving chronic care management services, for +30 minutes of clinical staff time

Remote Patient Monitoring Devices

Remote Patient Monitoring devices as part of the telehealth and RPM revolution, grant healthcare providers a holistic approach to patient care. These devices, covered under specific CPT codes like 99453, 99454, 99457, and 99458, cater to various facets of patient health, enhancing both the patients’ and providers’ experiences during their medical journey. Here, we delve into the wide array of RPM devices that contribute to this paradigm shift.

RPM Devices

1. Blood Pressure Monitor 

RPM is not just about collecting data but also about offering real-time insights. The Cellular Blood Pressure Monitor does precisely that for hypertension patients. It continuously records blood pressure data and shares it with healthcare providers, enabling proactive management of cardiovascular health. 

2. Weight Scale 

This device is indispensable for patients striving to manage their weight effectively. It records weight and BMI, which is especially crucial for those with chronic conditions, undergoing weight management programs, or post-surgery patients. It helps healthcare professionals assess progress and identify early signs of health concerns, promoting overall well-being. 

3. Pulse Oximeter 

Respiratory health is a paramount concern for those with conditions like COPD or asthma. The Cellular Pulse Oximeter measures oxygen saturation levels and heart rate, providing real-time assessments. By constantly monitoring respiratory health, this device allows healthcare providers to intervene promptly in case of irregularities, preventing complications. 

4. Blood Glucose Monitor 

A boon for diabetes patients, this device monitors blood glucose levels and transmits them in real-time. This continuous data helps both patients and healthcare providers in managing diabetes effectively, reducing the risk of complications. 

5. Cellular Thermometer 

Monitoring body temperature becomes critical, especially during pandemics and for patients with fevers. The Cellular Thermometer offers non-invasive temperature tracking and immediate data transmission, facilitating early identification of infections or complications. 

These devices are part of an evolving landscape in healthcare, enhancing patient care, promoting early interventions, and ensuring the best health outcomes. Remote Patient Monitoring under CPT codes has opened a new realm of possibilities, putting patients’ health back in their hands with a connected approach. To learn about the other devices not mentioned in this article, click here. 

Cost of RPM devices and distribution fees

Does CPT Code 99453 include the expenses related to the device?  

No, Medicare does not provide reimbursement for device costs or shipping, so healthcare providers should evaluate the cost-effectiveness and return on investment (ROI) of the RPM solution accordingly. 

That’s another reason why healthcare providers nationwide source RPM vendors like Neolytix who takes care of these costs, allowing providers to offer RPM to their patients, with zero upfront investment and access to risk-free revenue. 

Schedule a free demo today with Neolytix to learn how you can join the future of healthcare today.  

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