Here is a breakdown of the RPM CPT codes and reimbursements currently available:
| CPT Code | What it Covers | Who can bill | How Often | How Much Medicare Reimburses |
| 99453 | Initial Setup of Device | Not Specified; Not Required to be Clinic ... | Billed 1X Per Patient, Only First Month ... | $19.46 |
| 99454 | Device Supply With Daily Recordings and ... | Not Specified; Not Required to be Clinic ... | Billed Each 30 Days, Minimum of 16 Days ... | $64.15 |
| 99457 | 20 Minutes of Monitoring and Treatment M ... | In Indirect General Supervision of Clini ... | Billed Each Calendar Month | $51.54 (Non-Facility Rate) |
| 99458 | Each Additional 20 Minutes of Monitoring ... | In Indirect General Supervision of Clini ... | Billed Each Calendar Month | $42.22 (Non-Facility Rate) |
What are the new Medicare codes for remote patient monitoring?
These codes incentivize providers to effectively and efficiently use RPM technology to monitor and manage patient care needs. 1. Does Medicare Already Cover Remote Patient Monitoring? Yes. Even before the new codes, Medicare already offered separate reimbursement for RPM services billed under code 99091 .
How much does remote patient monitoring reimbursement pay?
If your practice enrolls just 50 patients into your RPM program and each receives the minimum care management services, that will earn you about $72,000 in annual Medicare remote patient monitoring reimbursement. Even after covering expenses associated, RPM yields significant and — importantly — consistent revenue.
What are the RPM service codes for remote patient monitoring?
Most of your remote patient monitoring services will be billed under four codes. These codes are often split into two categories: RPM "service codes" — 99453 and 99454 — and timed RPM "management codes" — 99457 and 99458. The RPM service codes descriptors are as follows:
What are the new RTM codes for Medicare?
The new RTM codes broaden the use cases for Medicare reimbursement of remote monitoring beyond the existing Remote Patient Monitoring (RPM) codes and represent one of the latest advancements to modernize reimbursement for digital health. The RTM Frequently Asked Questions below are based on CMS’ policies in the 2022 Final Rule.
What is the cost of remote patient monitoring?
Wide Range of Costs One of the world's leading authority of remote care, The Journal of Telemedicine and Telecare found that equipment purchasing, servicing and monitoring cost of RPM programs ranged from USD $275 to USD $7963 annually per patient.
How do you get paid for remote patient monitoring?
Remote Patient Monitoring is most commonly paid for by patient insurance coverage and by government healthcare such as Medicare. For Medicare patients, practitioners bill Medicare to be reimbursed for Remote Patient Monitoring services. Practitioners can bill Medicare by submitting CPT codes for various services.
How Much Does Medicare pay for code 99213?
A 99213 pays $83.08 in this region ($66.46 from Medicare and $16.62 from the patient). A 99214 pays $121.45 ($97.16 from Medicare and $24.29 from the patient). For new patient visits most doctors will bill 99203 (low complexity) or 99204 (moderate complexity) These codes pay $122.69 and $184.52 respectively.
How Much Does Medicare pay for 99441?
Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients effective March 1, 2020. This means that payment for CPT codes 99441-99443 would increase from a range of about $14-$41 to about $46-$110.
How do I start a remote patient monitoring business?
Remote patient monitoring works wonders for patient care....5 Best Practices for Starting an RPM BusinessKnow and Understand General Business Requirements. ... Know the Cost of Acquiring RPM Devices. ... Develop a Process and Hire Your Care Team. ... Think About Effective Patient Engagement. ... Be Aware of Billing and Reimbursement Codes.
How do I bill a CPT code 99091?
CPT code 99091 should be reported no more than once in a 30-day period to include the physician or other qualified health care professional time involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated ...
How do I calculate Medicare reimbursement for CPT codes?
You can search the MPFS on the federal Medicare website to find out the Medicare reimbursement rate for specific services, treatments or devices. Simply enter the HCPCS code and click “Search fees” to view Medicare's reimbursement rate for the given service or item.
What do CPT codes pay?
For example, payment for therapeutic exercise (CPT code 97110) will drop by an average of 3.3%, from $31.40 in 2020 to $30.36 this year, with manual therapy (97140) seeing a similar percentage decrease, from $28.87 in 2020 to $27.91 in 2021.
What is the reimbursement for CPT code 99213?
The 99213 is the second most popular choice for internists who selected this level of care for 36% of these encounters in 2019. The reimbursement for this level of care is $92.47 and is worth 1.3 work RVUs.
Does Medicare pay for remote patient monitoring?
Remote patient monitoring is covered by Medicare. As of July 2020, it's also covered by 23 state Medicaid programs, according to the Center for Connected Health Policy.
What is the reimbursement for CPT code 99441?
Coding claims during COVID-19 Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes) Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020.
Who can bill for CPT code 99441?
The following codes may be used by physicians or other qualified health professionals who may report E/M services: 99441: telephone E/M service; 5-10 minutes of medical discussion. 99442: telephone E/M service; 11-20 minutes of medical discussion.
What technology is covered by CPT code 99457?
Many advocates asked CMS to clarify the kinds of technology covered under CPT codes 99453, 99454, and 99457. Some groups gave examples of the kinds of technology they believe these codes should cover, such as software applications that could be integrated into a beneficiary’s smartphone, Holter-Monitors, Fitbits, or artificial intelligence messaging. Other examples included behavioral health data and data from wellness applications, or results of patients’ self-care tasks. Unfortunately, CMS did not offer any specifics in the final rule on what technology qualifies, but CMS does plan to issue forthcoming guidance to help inform practitioners and stakeholders on these issues. This may likely be in the form of a CMS MLN article or Q&A.
How long does it take to track a CPT 99457?
CPT 99457 is much easier to track because it is based on a calendar month, not 30-day periods. This will more easily align with recordkeeping and claims submission, as CPT 99457 is reimbursed on a monthly basis. 5.
What is CPT 99457?
CPT 99457 allows RPM services to be performed by the physician, qualified healthcare professional, or clinical staff. Clinical staff includes, for example, RNs and medical assistants (subject to state law scope of practice and state law supervision requirements). The inclusion of “clinical staff” is the most significant differentiator from CPT 99091, as that code is limited only to “physicians and qualified health care professionals.” All practitioners must practice in accordance with applicable state law and scope of practice laws. The term “other qualified healthcare professionals” used in CPT 99457 is a defined term, and that definition can be found in the CPT Codebook.
When will the new RPM codes go live?
Remote Patient Monitoring (RPM) is the next big thing in medical care; patients just don’t know it yet. And, it seems, neither do many physicians. On Thursday, CMS published the final rule on its new RPM codes, officially titled “Chronic Care Remote Physiologic Monitoring.” There are three new RPM codes, all of which will go live starting January 1, 2019. These codes incentivize providers to effectively and efficiently use RPM technology to monitor and manage patient care needs.
Is CPT 99091 a separate payer?
This failure may be due to the fact that CPT 99091 is 16 years old and had never before been a separately payable service. (It is an older code CMS “unbundled” and designated as a separately-payable service.) Indeed, the AMA’s CPT Editorial Panel developed and finalized the three new RPM codes in late 2017.
Does Medicare cover 99091?
Yes. Even before the new codes, Medicare already offered separate reimbursement for RPM services billed under CPT code 99091 . That service is defined as the “collection and interpretation of physiologic data (e.g., 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.” It went live for the first time on January 1, 2018.
Do RPM services require interactive audio?
RPM services to not require the use of interactive audio-video, as these codes are inherently non face-to-face. A few groups urged CMS not to be prescriptive regarding the technology that could be used to perform consultations, including real-time video, a store-and-forward visit, or simply a patient-provider message via a patient portal. CMS expressed sympathy with the desire not to be overly prescriptive about the technology used to furnish RPM services, and stated it CMS defers to the CPT code descriptors and guidance to ascertain the technological modalities used to furnish RPM services.
What is remote patient monitoring?
On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to remote patient monitoring aka remote physiologic monitoring or “RPM,” reimbursed under the Medicare program. The changes, part of the 2021 Physician Fee Schedule final rule are intended to clarify CMS’ position on how it interprets requirements for RPM services. This rule finalizes many of the proposals released in August 2020, and builds upon previous RPM guidance, including changes allowing general supervision for purposes of incident to billing .
What is the RPM code for Medicare?
The five primary Medicare RPM codes are CPT codes 99091, 99453, 99454, 99457, and 99458.
What is the CPT code for a 2 way audio interaction?
Read more at this link. In the 2021 Final Rule, CMS stated “interactive communication” for purposes of CPT codes 99457 and 99458 requires, 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.
How many days can a medical device be billed?
The correction stated, “even when multiple medical devices are provided to a patient, the services associated with all the medical devices can be billed by only one practitioner, only once per patient, per 30-day period, and only when at least 16 days of data have been collected.”. Read more at this link.
When will the 20 minute rule be implemented?
As a companion summarizing the key changes in the 2021 Final Rule, CMS issued a Fact Sheet on December 1, 2020, concurring with AMA’s position that the 20-minutes can include time for furnishing care management services as well as for the required interactive communication. It stated:
Does CMS allow telehealth?
Nowadays, state laws allow doctors to use telehealth to create a valid doctor-patient relationship for new patients. 4.
Is the established patient restriction waived?
CMS waived the “established patient” restriction during the Public Health Emergency (PHE) but in the 2021 Final Rule, CMS declined to extend such waiver beyond the PHE.
What is the RPM code for a physician?
RPM code 99457 allows RPM services to be performed by the physician, qualified healthcare professional, or clinical staff. Clinical staff includes, for example, RNs and medical assistants (subject to state law scope of practice and state law supervision requirements). The inclusion of “clinical staff” is the most significant differentiator from code 99091, as that code is limited only to “physicians and qualified health care professionals.” All practitioners must practice in accordance with applicable state law and scope of practice laws. The term “other qualified healthcare professionals” used in code 99457 is a defined term, and that definition can be found in the CPT Codebook.
What technology is covered by RPM code 99457?
Some groups gave examples of the kinds of technology they believe these codes should cover, such as software applications that could be integrated into a beneficiary’s smartphone, Holter-Monitors, Fitbits, or artificial intelligence messaging. Other examples included behavioral health data and data from wellness applications, or results of patients’ self-care tasks. Unfortunately, CMS did not offer any specifics in the final rule on what technology qualifies, but CMS does plan to issue forthcoming guidance to help inform practitioners and stakeholders on these issues. This may likely be in the form of a CMS MLN article or Q&A.
How long is a RPM for 99091?
At least 20 minutes per calendar month. This differs from code 99091, which requires at least 30 minutes per 30-day period . RPM code 99457 is much easier to track because it is based on a calendar month, not 30-day periods. This will more easily align with record keeping and claims submission, as code 99457 is reimbursed on a monthly basis.
Do RPM codes require face to face examination?
No. The codes do not contain an express requirement for a face-to-face examination in connection with providing RPM services. Further, RPM services to not require the use of interactive audio-video, as these codes are inherently non face-to-face. A few groups urged CMS not to be proscriptive regarding the technology that could be used to perform consultations, including real-time video, a store-and-forward visit, or simply a patient-provider message via a patient portal. CMS expressed sympathy with the desire not to be overly proscriptive about the technology used to furnish RPM services, and stated it CMS defers to the code descriptors and guidance to ascertain the technological modalities used to furnish RPM services.
Does Medicare cover 99091?
Yes. Even before the new codes, Medicare already offered separate reimbursement for RPM services billed under code 99091 . That service is defined as the “collection and interpretation of physiologic data (e.g., 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.” It went live for the first time on January 1, 2018.
Is 99091 a CMS code?
This failure may be due to the fact that code 99091 is 16 years old and had never before been a separately payable service. (It is an older code CMS “ unbundled” and designated as a separately-payable service.) Indeed, the AMA’s CPT Editorial Panel developed and finalized the three new RPM codes in late 2017.
Do you have to get consent for RPM?
Yes, the practitioner must get the patient’s consent for RPM services and document it in the patient’s medical record. Although CMS did not directly address this in the final rule for the new codes, it is a requirement for code 99091 and can likely be expected as a requirement for codes 99453, 99454, and 99457. 13.
How to use remote patient monitoring with telehealth
Remote patient monitoring pairs well with telehealth when patients need to be monitored for certain health conditions. It can also prevent health complications in patients who aren’t able to easily travel.
How to help patients use at-home health monitors
Remote monitoring may be new for your patients, and for you also. The best way to help your patients is to be informed about the devices you will be using. This includes how they work and how you will receive the data from the device.
Billing and payment for remote physiologic monitoring
While private insurance companies set their own terms, Medicare has its own payment policies.
Some Good (And Not So Good) Reactions
One of the criticisms of the RTM codes is that they don't cover enough conditions.
Looking to the Future
The codes give healthcare providers some reimbursement for new RPM services, and they represent a subtle step forward. And they fall in line with CMS' line of thinking, which has always been that it wants to see proof that these technologies improve clinical outcomes and reduce wasteful expenses before they're embraced by federal regulators.
KEY TAKEAWAYS
CMS has been incrementally expanding coverage for remote patient monitoring since first recognizing the platform in 2019.
What are the Remote Therapeutic Monitoring codes?
RTM is a family of five codes created by the CPT Editorial Panel in October 2020 and valued by the RVS Update Committee (RUC) at its January 2021 meeting. The RTM family includes three practice expense (PE)-only codes and two codes that include professional work. The new RTM codes are:
Can RTM be used for non-physiological data?
Yes. RTM is designed for the management of patients using medical devices that collect non-physiological data. Data around indicators such as therapy/medication adherence, therapy/medication response, and pain level can be collected and billed under the new RTM codes.
Is RTM limited to respiratory and musculoskeletal conditions?
Yes, the clinical use cases eligible for device supply reimbursement under RTM are limited. The two RTM device supply codes (98976, 98977) are similar to the RPM device supply code (99454), but not identical. CPT code 99454 does not restrict the clinical or biological systems being monitored, although the data must be physiological.
How are RTM codes classified?
The RTM codes are classified as general medicine codes and not Evaluation and Management (E/M) codes. In contrast, RPM is classified as an E/M service.
What practitioners can order and deliver RTM?
Physicians and eligible qualified healthcare professionals are permitted to bill RTM as general medicine services.
Is incident to billing under general supervision allowed for RTM?
No. Because the two RTM treatment management codes (CPT codes 98980 and 98981) are not E/M codes, they cannot be designated as care management services. This means a physician could not order and bill for RTM services while having remote-based non-physician practitioners perform the work under general supervision.
How many minutes of service are required for RTM?
CPT code 98980 requires a minimum of 20 minutes of time in a month, dedicated to remote therapeutic monitoring treatment management of the patient. This time must also include at least one interactive communication with the patient/caregiver during the month (e.g., via phone or video).