An Overview of 2020 Remote Patient Monitoring RPM CPT Codes
Though some clinics began their digital journey before COVID-19, recent times have certainly challenged traditional workflows and innovative ways of collaborating with patients have emerged. A fundamental element in these approaches is the ability for patients to capture health data at home and electronically share relevant data with their health care teams to enable optimal clinical care. This shift has enabled improved quality and quantity of data, giving providers the ability to better monitor patients between scheduled appointments, whether virtually or in person.
To help healthcare providers keep up with the growing need for remote care, the Centers for Medicare and Medicaid Services (CMS) developed remote physiologic monitoring (RPM) CPT codes in 2018 and 2019 which were expanded in 2020.
There are several key CPT Codes currently available, which allow for Medicare reimbursement of costs for the initial set-up and training with patients, monthly operational costs, ongoing monitoring of patient data and communication with patients. Amounts provided are estimated from 2020 CMS national physician fee schedules for facilities. Fees for non-facilities can be higher.
CPT Code 99453: Patient Set-Up and Education/One-Off
This is a one-time expense, reimbursed at ~$19 for patient set-up of remote monitoring equipment. This includes training and education on the equipment and any other onboarding processes included.
CPT Code 99454: Operational Costs/Monthly
This code covers operational costs at ~$62 for the supply of devices with recording and transmission of data. The code can be applied each 30-day billing cycle with a required minimum 16 days of device readings shared by the patient under the 30-day period. A physician or QHP must order the device for the patient and devices cannot be purchased, leased-to-own or already in the possession of the patient.
CPT Code 99457: Patient Communication/Monthly
This code is for interactive patient communication around remote monitoring of physiologic data (e.g. respiratory flow rate, weight, pulse oximetry, etc.) as part of the treatment management of a patient. A physician or QHP must provide services for at least 20 minutes per month. Interactive communication includes communication by phone, video, email, text, etc. Services during this communication could include review and interpretation of submitted data and joint coordination with patients around treatment plans. The code can be billed once a calendar month for a reimbursement of ~$33. The use of this code requires a “treatment plan” to be in place.
CPT Code 99458 (2020 NEW): Additional Patient Communication/Monthly
This is an add-on code for CPT Code to 99457 which can be used for an additional 20 minutes of interactive communication for remote monitoring and treatment management services with a patient. Providers could be reimbursed for ~$33 and extra 20 minutes sessions can be billed twice per month. This allows for up to 60 minutes of interactive communication per month when using code 99457 once with 99458 twice a month.
CPT Code 99091: Review and Interpretation of Data/Monthly
This code can be used for reimbursement for a minimum of 30 minutes each 30 days of physician or QHP time dedicated to remote monitoring services, not requiring interactive communication with the patient. Services can include the collection and interpretation of physiologic data digitally stored and/or transmitted by a patient. It’s important to note that code 99457 and 99091 cannot be billed concurrently. Reimbursement is ~$59.
To summarize, monthly billing can consist of a combination of CPT codes 99453, 99454, 99457 and 99458 OR 99453, 99454 and 99091.
A few important points for providers to remember:
- Eligibility requirements and coverage is determined by each individual public or private payor.
- The patient must opt-in and there must be an established patient-provider relationship before the RPM program begins.
- Devices used for RPM must be FDA defined as a medical device with data electronically collected and transmitted.
- Remote monitoring under these codes can be provided “under general supervision” of a physician, which allows other qualified healthcare professionals (QHP) to order and provide services.
- Documentation of services should be kept and shared as needed.
Visit the CMS website for the latest updates and contact your payor for specific billing questions. Feel free to contact firstname.lastname@example.org for questions regarding the NuvoAir Home respiratory platform.