In the beginning, RPM was very much uncharted territory and program managers had to navigate many regulatory uncertainties. At present, the Centers for Medicare and Medicaid Services (CMS) have made several amendments related to RPM that benefits both Medicare recipients as well as healthcare providers. In this FAQ, we answer all your questions about RPM and Medicare.
10 Questions About Medicare and Remote Patient Monitoring—Answered
Q: What is RPM?
A: RPM involves the use of technology to collect patient health data remotely to develop and manage a treatment plan related to a chronic or acute health condition.
Q: How does RPM work, exactly?
A: RPM typically involves the use of wearable devices or sensors that collect data about a patient’s health status. That data is then transmitted to a secure platform where it can be monitored by the healthcare provider.
Q: Does Medicare cover RPM?
A: Most patients under Medicare do not have to pay for RPM services. However, Medicare B patients are still responsible fir 20% coinsurance. In November 2021, CMS expanded Medicare coverage for RPM. Patients can now receive telehealth services from their homes at zero cost instead of having to drive to a CMS-qualified telehealth service center.
Q: Do patients with only chronic conditions qualify for RPM?
A: No. In 2021, the CMS clarified that patients with acute and chronic conditions are eligible for RPM services.
Q: Do patients in rural areas and nursing homes qualify?
A: Yes, both patients in nursing homes and rural areas qualify for RPM.
Q: Do both new and established patients qualify?
A: Yes—for now. CMS’s 2021 Final Rule stated that RPM services are limited to “established patients.” However, for the duration of the COVID-19 public health emergency (PHE), CMS waived the “established patient” requirement and allowed practitioners to bill for RPM for new patients.
It’s important to note that CMS declined to extend the waiver beyond the PHE. Once the PHE is over, an established patient-practitioner relationship will be required to bill Medicare for CPT 99453, 99454, 99457, and 99458.
Q: Who can provide RPM services?
A: The collection and evaluation of patient data (CPT code 99091) can only be carried out by a physician or qualified healthcare professional. However, other services such as remote physiologic monitoring services (CPT codes 99457 and 99458) can be furnished by a physician, a qualified healthcare professional, or clinical staff under the general supervision of the physician
In the 2021 Final Rule, CMS allowed auxiliary personnel, in addition to clinical staff, to provide specific RPM services under the general supervision of the billing physician or practitioner. Auxiliary personnel include other individuals who are not clinical staff but are employees of the facility. The services they are allowed to give are initial set-up and patient education services (CPT code 99453) and providing the devices used by patients to monitor and record data (CPT 99454).
Q: What devices are approved for RPM services?
A: The RPM device needs to meet the FDA’s definition of a medical device as described in section 201(h) of the Federal, Food, Drug and Cosmetic Act.
The device must digitally and automatically upload patient physiologic data to the healthcare facility. The devices also need to transmit valid physiological data to understand the patient’s health status to develop and manage a treatment plan.
Q: Are patients permitted to report their own data?
A: No. Other forms of self-reporting, like manually inputting data into a patient portal, may qualify for other Medicare-covered services; however, data collected this way cannot be counted towards RPM. RPM device measurements must sync automatically with a provider’s remote patient monitoring platform without patient transcription.
Q: Who can order and bill for RPM services?
A: Only physicians or non-physician practitioners who are eligible to bill Medicare for evaluation and management services can order and bill for RPM services.
Keep Up-to-Date with Medicare Reimbursement
As RPM becomes more prevalent, healthcare providers have an opportunity to drive their bottom line while continuing to provide quality care for their patients. Learn how you can get reimbursed accurately for your RPM program with this CPT code cheat sheet.