Does Medicare cover Remote Patient Monitoring?
Yes. Since January 2018, Medicare has reimbursed services billed under CPT 99091. Newer CPT codes were activated effective 2019 and do a better job of describing how RPM services are administered with emerging technology. We’ve outlined the new important CPT codes to know below.
CPT Codes To Know:
99453: Remote monitoring of physiological data (weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
$18.77 (one time payment)
99454: Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
$62.44 (every 30 days per patient)
99457: (Physician or auxiliary professional) remote physiologic monitoring treatment management services that require 20 minutes of live (non-face-to-face), interactive communication (e.g. monitoring, etc.) between the patient/caregiver and the clinical staff/ physician/other qualified healthcare professionals (QHCP) in a calendar month. $51.61 (each calendar month per patient)
99458: reported in conjunction with 99457 to report each additional 20 minutes of time. $42.22 (each calendar month per patient)
What the Medicare-specific administrative requirements?
There are several administrative requirements specific to Medicare, including:
Tracking time spent for each code
Entering the correct CPT code at the right time
Assigning time spent to the correct staff member
Recording time communicating with patients
It is important to track these data points1) reduce time spent on documentation and administrative burden 2) maximize revenue through capitalizing on reimbursement opportunities and 3) comply with CMS rules and protect you from potential problems if audited by Medicare.
What technologies can be used to administer RPM services under the new reimbursement codes?
The Centers for Medicare & Medicaid Services (CMS) has not offered clear guidance on the technology services that can be reimbursed under CPT codes 99453, 99454 and 99457, however, the device used must be a medical device as defined by the FDA. CMS plans to issue future guidance to inform practitioners and patients.
What changed in 2020 with relation to CPT codes?
CPT code changes in 2020 create further opportunity to maximize revenue and receive clinical benefits. We’ve summarized some of the most important changes here:
CPT code 99457 was approved as base code that describes the initial 20 minutes of the physiological monitoring treatment management services. Als notable is the RPM add-on code (CPT Code 99458), approved for each additional 20 minutes of treatment management.
Both of these codes (99457 and 99458) have been designated as care management codes, allowing general supervision for RPM services (a shift from the old codes which only allowed for direct supervision). This means that under 99457 the “physician or other qualified healthcare professional supervising the auxiliary personnel need not be the same individual treating the patient more broadly.”
In addition, CMS finalized a number of other changes that help to broaden digital medical services.
Not only do these changes improve reimbursement avenues for clinicians and generate revenue, they also enable practitioners to take on more RPM clients because most of the tasks can be handled by entry-level assistants and RN’s and automated with an easy-to-use RPM system.