CPT 99091 can be billed by a physician or qualified healthcare professional (QHP) for a minimum of 30 minutes of time spent collecting, reviewing, interpreting, and reporting of remote physiologic monitoring data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other QHCP, in addition to at least one communication (e.g., phone call or email exchange) with the patient to provide medical management and remote monitoring recommendations. CPT code 99091 can be billed once monthly.
What Are the RPM (Remote Physiologic Monitoring) CPT Codes for Patient Services?
RPM services can be furnished under general supervision. It can be billed along with CCM or PCM services in the same month.
Collecting and Analyzing Physiologic Data by a provider
Providing Set-up and Training of device for the patient
All auxiliary personnel (including clinical staff and non-clinical) may provide education to patients on RPM services and set up of the remote physiologic device under CPT code 99453. The healthcare personnel can be either contracted or employed by the billing practitioner. This means that RPM equipment vendors or RPM care management services vendors can provide the education and set-up of the monitoring device.
16 Days of Patient Monitoring
Use CPT Code 99454 to bill for the collection and continued monitoring of the remote physiologic device(s). This monitoring must occur over at least 16-days of a 30-day period to fulfill medicare requirements. Remote Physiological Monitoring services can only be billed by one practitioner per 30-day period and cannot be reported for a patient more than once during a 30- day period (even when multiple medical monitoring devices are provided to a patient).
Remote physiologic monitoring (RPM) services for 20 to 39 minutes
Chronic care remote physiologic monitoring (RPM) services involve the collection, analysis, and interpretation of digitally collected physiologic data by managing a patient under their treatment plan. CPT Code 99457 is billable for clinical staff/physician/other qualified professional time with a patient in a calendar month for 20 to 39 minutes. (approx. $51.54)
Remote physiologic monitoring (RPM) services for each additional 20 to 39 minute interval
Chronic care remote physiologic monitoring (RPM) services involve the collection, analysis, and interpretation of digitally collected physiologic data by managing a patient under their treatment plan. CPT Code 99458 is billable along with for CPT 99457 for clinical staff/physician/other qualified professional time with a patient in a calendar month for each additional 20 minutes up to 2 units. (approx. $43)
What are the requirements for remote physiologic services?
First, a patient needs to give informed consent (verbal or written) to the practice to receive RPM services.
Then, to bill for CPT 99453, the following needs to be documented:
- Provider needs to order for device deployment
- Documentation of qualifying condition(s) for which the patient is being monitored
- Device identification needs to be documented
- Delivery date of the device to the patient
- Date(s) education and training provided to the patient
To document CPT 99457 and 99458 the time spent on each and scope of services needs to be documented.
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FAQs
Who can bill for remote physiologic monitoring?
Remote physiologic monitoring can be billed by a physician or qualified health professional (QHP) for RPM services (CPT codes 99091, 99453, 99454, 99457, 99458) for patients with acute and chronic conditions.
Does Medicare reimburse for remote patient monitoring?
Yes, Medicare (CMS) pays for remote monitoring services, which generally use digital technologies (primarily medical devices along with software) to collect medical and additional health data from patients in one location to electronically transmit the information to the patient’s chart. Medicare B patients are still responsible for 20% coinsurance unless they have a secondary or Medicare Advantage plan that pays for remote patient monitoring in full.
What is the maximum amount of time remote CGM monitoring can be billed per month?
The maximum amount of time remote CGM Monitoring can be billed is for an entire month. The minimum amount of remote CGM monitoring in order to be billable to Medicare is 72 hours of CGM data printed from the device that the patient was trained on in order to bill.
CPT Code 95250 and CPT Code 95251 can both be billed for remote CGM. CPT Code CODE 95250 can be billed for sensor placement, sensor training, removal of sensor, and printout of the recording. The CPT Code 95250 descriptor of the code does include insertion as well as removal of CGM. The transmitter needs to be returned to the office by the patient for analysis and reporting. Then, CPT Code 95251 would be returned to the office for the analysis, interpretation and report. Both codes can be billed once a month and do require a minimum of 72 hours of CGM of data. The frequency you can bill these codes may vary by payer. Some may only allow you to bill twice a year and the others may require medical necessity but do not have any limits on the frequency of billing. However, regardless of the payer limitation the codes cannot be billed more than once per month which is defined by the AMA.
Who needs remote patient monitoring?
Remote patient monitoring can be helpful to providers when patients are monitored for certain health conditions in between office visits remotely from home, work or traveling to know immediately if they need medical attention. Additionally, it can help prevent health complications by allowing providers to monitor their patients remotely who are unable to travel or homebound.
There are many symptoms and conditions that can be tracked through remote patient monitoring, including patients with the following:
- Diabetes
- High blood pressure
- Obesity
- Weight loss or gain
- Heart conditions (i.e. Congestive Heart Failure (CHF))
- Chronic obstructive pulmonary disease
- Sleep apnea
- Asthma
- Parkinson’s Disease
What is the difference between RTM and RPM?
Remote Therapeutic Monitoring (RTM)
Remote Therapeutic Monitoring (RTM) codes are for monitoring specific non-physiologic (including self-reported) or specific therapeutic parameters in between office visits that are critical to improving patient outcomes.
RTM services require the use of a FDA-defined device ( including software that fits the definition of a medical device) with a minimum of 16 days of readings per month to be collected and billed for under RTM. RTM can be billed by a Physician or Qualified Health Care Professional (QHCP), who can bill general medicine codes, including physical therapists (PTs), occupational therapists (OTs), speech-language pathologists, dieticians, psychologists can bill for RTM services.
RTM codes can be used for health conditions such as: musculoskeletal system status, respiratory system status, therapy adherence, and therapy response, And, RTM data can be self-reported (such as medication adherence or pain levels), entered manually into a device, and digitally uploaded by the patients themselves.
Remote Physiologic Monitoring (RPM)
Remote Physiologic Monitoring (RPM) codes are for monitoring specific physiologic parameters in between office visits that are critical to improving patient outcomes.
RPM services require the use of a FDA-defined device with a minimum of 16 days of readings per month to be collected and billed for under RPM. RPM can be billed by a Physician or Qualified Health Care Professional (QHCP), who can bill for E/M services can bill for RPM services.
RPM codes can be used for health conditions such as: diabetes, hypertension, COPD, obesity and CHF when physiologic devices are used to And, RTM data can be self-reported, entered manually into a device, and digitally uploaded by the patients themselves.
Both RPM and RTM codes do not have a diagnosis requirement, however, both services need to be medically necessary in order to bill for these services.
Does CMS cover remote patient monitoring?
Yes, CMS covers remote patient monitoring services, which usually use digital technologies (primarily medical devices, along with software) to collect medical and other health data from patients in one location to electronically transmit the information to the patient’s provider or clinical staff in another location. Medicare B covers 80% of the payment and patients are still responsible for the 20% coinsurance unless they have a secondary or Medicare Advantage plan that pays for remote patient monitoring in full. Remote patient monitoring is a form of telehealth and includes both remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM).
How does CMS define remote patient monitoring?
Remote patient monitoring is a form of telehealth that allows providers to monitor and manage their patients’ chronic conditions.
What are the requirements for RPM?
To qualify for RPM, patients must consent and use an FDA-defined medical device to capture and transmit physiologic data. Providers, QHCP and/ or clinical staff must conduct the monitoring.
The requirements for gaining RPM consent for enrollment are as follows:
- The patient must give a verbal or written consent to participate.
- The devices must be FDA defined device and ordered by a qualified medical professional.
- Data received from the devices must be wirelessly synced (via cloud, bluetooth, etc…).
- Monitoring is performed by a clinical team member such as: physician, a qualified healthcare professional, or clinical staff (licensed nurses/medical assistants), subject to state law.
Additionally, to bill for RPM CPT Service Codes, additional requirements must be met. To bill for CPT Code 99454 readings needed to be taken for at least 16 out of 30 days. The full scope of services needs and the required minimum time threshold needs to be met if billing CPT Code 99091, CPT Code 99557 and CPT Code 99458. In order to bill CPT Code 99453 set up, education and training needs to be completed with the patient on the RPM device.
What are the typical specialties that offer remote patient monitoring services?
Specialties frequently embracing RPM include cardiology, neurology, pulmonology, endocrinology, bariatrics and gastroenterology.
How do I ensure I have a HIPAA compliant RPM program?
It is important when choosing a RPM vendor their RPM devices and technology are compliant with FDA standards. These devices need to be built so that patient data is encrypted when patient data is in transit to the provider and vice versa as well as at rest when the device that stores the data is not in use.
What are different types of RPM programs available to providers?
Providers usually choose from a self-managed or outsourced full-service program. The following summarizes the essential differences between these programs:
For a practice taking a self-managed approach, a practice usually maintains their own set of devices (usually cloud or bluetooth enabled) and contracts with an RPM software vendor to manage the data being transmitted from those devices to the practice. In the self-managed approach the practice provides ongoing technical support for patients with these devices. Taking a self-managed approach may be less expensive over the long term for a practice. However, it will require additional upfront costs to pay for practice resources to provide technical assistance, clinical staff to provide remote monitoring services along with additional upfront costs for the devices.
For a practice having an outsourced full-service program, a practice contracts with an RPM company to supply patients with devices and care team. The practice can decide to hold an inventory of the devices to distribute to patients or have the vendor send devices to the patients as the office enrolls the patients to receive RPM services. Many outsourced full-service programs allow practices to lease the device which helps decrease upfront costs for each new patient onboarded.
Devices a practice provides are usually cloud based or bluetooth enabled. Additionally, full-service programs can offer technical support for their patients. Monthly costs may be a higher percentage of reimbursement due to the convenience of not incurring the staffing, hardware, hiring, insurance, managing auditing and training costs.