With telehealth and remote patient monitoring (RPM) services becoming a mainstay in the US healthcare industry, healthcare organizations must keep up with RPM billing guidelines to receive reimbursements from the Center for Medicaid and Medicare Services (CMS). 

In this article, We’ll look at the best practices for remote patient monitoring, billing, and CMS reimbursement to help your organization get fairly reimbursed for implementing RPM. 

Using RPM With Telehealth 

Combining remote patient monitoring with telehealth works best when you have patients who require biometric monitoring for specific conditions. It is also beneficial for patients who have difficulty traveling and are unable to visit your healthcare facility regularly.

To begin implementing RPM services for your organization, consider the following: 

  1. The type of RPM services you want to provide 
  2. The goals and objectives for your RPM service 
  3. The RPM devices you will need (and how you will obtain them) 
  4. A plan for getting patient buy-ins 
  5. Staff training and patient education 
  6. Billing, coding, and reimbursement. 

At HRS, we have considerable experience in assisting with setting up and implementing RPM solutions for our clients. Feel free to reach out to us for advice or assistance. 

Billing & Payment For RPM 

For private insurance, you will need to check with the patient’s insurance company for information on their billing and reimbursement policies. 

For Medicaid, each state will have its own distinct remote patient monitoring billing and reimbursement policies, which you will check via the National Policy Center website. 

As for Medicare, the policies governing its payment policies are universal and are as follows: 

  • Have an established patient-physician relationship. 
  • Consent to receive remote physiologic monitoring services is permitted when services are provided. 
  • Remote physiologic monitoring services may be billed by physicians and non-physician practitioners eligible to provide evaluation and management services (E/M) 

What RPM Devices Qualify For Medicare? 

RPM devices must meet the FDA definition of the device, which is as follows: 

“Radio frequency (RF) wireless medical devices performing at least one function that utilizes wireless RF communication such as Wi-Fi, Bluetooth, and cellular/mobile phone to support health care delivery,” — FDA, Wireless Medical Devices 

Patients must not be allowed to self-report or self-record data via RPM devices, and the RPM device must automatically upload patient measurements and data. Furthermore, RPM services and devices provided to Medicare beneficiaries must aid in treating or managing a patient’s condition.  

Reimbursement via CPT Codes  

Keeping precise records of RPM reimbursements directly impacts the bottom line of your healthcare organization, so it’s essential to understand and record the correct CPT codes to receive accurate reimbursement. 

RPM Setup/Education Code (CPT 99453) 

CPT code 99453 accounts for the time spent on the initial setup. This includes clinical staff onboarding patients for RPM services, such as explaining how the device works and establishing a treatment schedule. 

Practices can only use the code 99453 once per clinical care episode (the time from service activation to treatment ends). This is true even if the patient sees multiple clinicians or uses multiple RPM devices. 

Device Based Code (CPT 99454) 

CPT Code 99454 covers patient monitoring and continuous device supply. Leasing fees for medical equipment used for remote patient monitoring are also included in this code. Code 99454 also includes leasing fees for medical equipment used for remote patient monitoring and covers the monthly servicing costs of devices and treatment services.  

Time-Based RPM Codes (CPT 99457, 99458, 99091) 

CPT Code 99457 reimburses care coordination and physician-patient interaction. It necessitates at least 20 minutes of interactive, virtual communication per month.  

CPT Code 99458 covers each additional 20 minutes of interactive, virtual communication during one calendar month. You must use CPT code 99458 in conjunction with CPT code 99457.  

CPT Code 99091 is also a time-based code that covers data collection and interpretation by a physician or QHCP for a minimum of 30 minutes. 

Better Understand CMS and RPM with HRS 

HRS collaborates with providers across the care continuum to deliver high-quality remote patient monitoring solutions that improve care coordination, achieve better outcomes, and lower costs. 

Contact our team of reimbursement specialists for more information on CPT codes, Medicare reimbursement updates, and best practices for your RPM billing for information on RPM implementation, billing, and reimbursement. 

Learn more with our RPM CPT Codes guide 👇Read the RPM CPT Codes Guide