RPM Overview

Remote Patient Monitoring CPT Codes summary - 2022

Healthcare organizations and patients are widely adopting telehealth as a reliable method of providing care, mainly due to the increased demand for digital solutions brought about by the COVID-19 pandemic. As telehealth becomes a standard aspect of patient care, it is crucial for healthcare providers to ensure proper reimbursement to maintain financial stability.

In this guide, you will find a simple and easy-to-use overview of the five essential Remote Patient Monitoring CPT codes (RPM CPT codes) that are most relevant to your RPM program.

  1. CPT 99453: Initial setup and patient training on equipment (one-time charge).
    • Reimbursement fee: $19.04
  1. CPT 99454: Provision of devices, data collection, transmission, and report/summary of services to the clinician.
    • Reimbursement fee: $55.72
  1. CPT 99457: Remote physiologic monitoring services by clinical staff/MD/QHCP for the first 20 cumulative minutes of RPM services within a 30-day period.
    • Reimbursement fee: $50.18
  1. CPT 99458: Remote physiologic monitoring services by clinical staff/MD/QHCP for an additional cumulative 20 minutes of RPM services within a 30-day period.
    • Reimbursement fee: $40.82
  1. CPT 99091: Collection and interpretation of data by physician or QHCP for 30 minutes.
    • Reimbursement fee: $56.41

*Please note that pricing may vary based on location and is subject to change*

 

CPT Code 99453:

This code is used for the initial setup of remote monitoring of physiological parameters and covers the supply of devices that patients use to monitor and record physiological data, as well as the daily recording or programmed alert transmission, for a period of 30 days.

CPT Code 99454:

This code is used for the monthly remote monitoring of physiological
parameters and covers the supply of devices that patients use to monitor and
record physiological data. 

CPT Code 99457:

This code is used to provide reimbursement for care coordination and
physician-patient interaction. It requires at least 20 minutes of interactive,
virtual communication during one calendar month.

CPT Code 99458:

This code covers additional 20 minutes of interactive, virtual
communication provided during one calendar month.

CPT Code 99091: 

This code covers the collection and interpretation of physiological data digitally stored and/or transmitted by the patient and/or caregiver to the the physician or other qualified healthcare professional (QHCP). It requires a minimum of 30 minutes spent by the physician or QHCP.

 

CPT Code FAQs

  1. What devices are approved for RPM services?
  • Any device used must meet the FDA’s definition of a “medical device” and must automatically upload patient physiologic data. Examples of approved devices include:
  • Blood pressure cuffs
  • Pulse oximeters
  • Heart rate monitors
  • Glucometers
  • Thermometers
  • Weighing scales
  • Spirometers

 

  1. Who qualifies for CPT Code 99453 and CPT Code 99454?
  • Practitioners may furnish RPM services to patients with acute and chronic conditions, according to CMS' 2021 Final Rule. In the past, RPM services were billable only if delivered for 16 days. However, a waiver issued during the COVID-19 pandemic permitted providers to bill for RPM services for patients with suspected or confirmed COVID-19 for fewer than 16 days but at least two days. This is known as the "2-day RPM requirement." However, it is essential to note that the "16-day RPM requirement" still applies for CPT code 99453 and CPT code 99454, which requires using a medical device that digitally collects and transmits 16 or more days of data every 30 days for billing.

 

  1. Is the cost of the device covered under CPT Code 99453?
  • No, the cost of purchasing RPM devices is not covered under CPT Code 99453. Healthcare providers should consider the cost-effectiveness and return on investment of the solution when purchasing devices.

 

  1. Can a third party provider deliver CPT Code 99453 services on behalf of the primary provider?
  • Yes, CPT codes 99091 and 99457 are reimbursable by Medicaid, and reimbursement may vary by private insurers. Partnering with a third-party provider for device delivery and setup logistics allows primary providers to focus on patient care.

 

Take the first step towards improving patient care and increasing revenue with our expert guidance on Remote Patient Monitoring. Our Revenue Cycle Management team is ready to assist you with understanding and optimizing reimbursement for your RPM program. Don't wait, access our financial modeling tools now to estimate the potential reimbursement for your program and contact us for any additional support.