Remote Patient Monitoring System and Telehealth Services

Among some of the drawbacks of rpm is a patient may not be able to afford the device, patients may not have reliable internet connectivity and/ or the patient may have difficulty using the technology or not always remember to use it when needed.

Remote monitoring is a component of telehealth systems. Telehealth is a broader term consisting of telemedicine, remote patient monitoring (RTM and RPM), and chronic care management.

Remote patient monitoring is the ability for a provider, QHCP (qualified health care professional) and/ or clinical staff to monitor a patient remotely based on their medical condition(s) using physiologic or non-physiologic data from a FDA defined device when the patient is remotely located.

Many commonly used patient monitoring devices for rpm are as follows: glucometer, continuous glucose meter (CGM), blood pressure cuff, thermometer, pulse oximeter, weight scale and wearables such as activity trackers. Many important health insights can be gained by these virtual devices, giving healthcare providers more data about their patients overall health.

Remote health monitoring may seem to be expensive if a patient’s insurance does not pay for the service. However, in the long term a patient monitoring system can decrease the overall cost of care for the patient and keep them out of the hospital and/or ER. This is why an increasing number of insurance companies have decided to pay for this service for their patients since monitoring a patient and catching any health concerns early can keep them out of the hospital which not only decreases patient costs but insurance costs as well.

Yes, Medicare pays for RPM services as long as they are medically necessary based on the patient’s condition. Traditional Medicare pays for the first 80% of cost and secondary insurance would pay for the remaining 20% coinsurance. However, if the patient does not have a secondary insurance it will be the patient’s responsibility to pay the 20% coinsurance amount when RPM services are given consent and received in a given month. We have found that Medicare Advantage plans have typically paid for RPM services in full.

RPM is covered by private insurance companies such as:

• Cigna
• Aetna
• Blue Cross Blue Shield
• Aetna
• Mutual of Omaha
• Manhattan Life
• Bankers Fidelity
• Western United Life

Remote patient monitoring can fail for a few major reasons:

1. Patients do not have access to reliable internet connectivity to transmit the telehealth data.
2. Patients are not tech savvy enough to remember how to use the rpm device after they are trained.
3. If patient does not have cloud connectivity with their remote physiologic monitor they need to make sure they have their bluetooth synced . If patients are using OCR (optical character recognition) the patient needs to remember to snap a picture of their monitor and have it uploaded to be read
4. If a remote patient monitor is given to a patient who is not wanting to participate in such remote patient home services then they will not comply
5. A well thought out patient home monitoring program has not been planned out to be executed and gaps are in the rollout
6. Not having the appropriate clinic staff available to monitor and act upon the urgent physiologic data coming in to help the patient at the time it is needed leading to patients no longer participating in a telehealth or rpm program.
7. Not explaining the value of the rpm program in the best manner leading to patients not wanting to participate in patient monitoring programs..

There are many aspects to setting up a successful rpm program from identifying what remote patient monitors are your preferred devices to use with patients, to deciding if you are going to work with the healthcare devices the patients already are using, to selecting the best remote patient monitoring software to fit your practice’s needs.
Your healthcare organization will also need to decide if you will outsource a portion or the entire service offering to a remote patient monitoring services vendor. Examples of areas of outsourcing would be as follows:

1. Gaining patient consent for digital data collection
2. Setting up, training and educating patients on how to use their remote monitor and upload the data to the practitioners’ system
3. Having the remote patient monitor services company supplement your existing clinical staff or completely outsource your clinical staff to provide these rpm services to your patients.
4. At times the vendor who provides the remote patient monitoring software can be your outsourced clinical care team as well.

According to the Medicare Physician Fee Schedule for CPT Code 99454 the national payment amount is $50.15 which can vary by locale. CPT code 99454 is for the collection and continued monitoring of the remote physiologic device(s). This digital monitoring needs a minimum of 16-days of a 30-day period to fulfill Medicare requirements. Remote Physiological Monitoring services can be billed by only one telehealth practitioner per 30-day period and can only be reported for a patient once during a 30- day period.

Remote Monitoring is billed on a monthly basis by one practitioner and cannot be reported for a patient more than once during a 30- day period (even when multiple digital telehealth rpm devices are provided to a patient).

There are five (5) Medicare payment codes for remote patient monitoring:

CPT Code 99453: Providing Set-Up, Education & 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 and train the patient to use 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, training and set-up of the monitoring device. CPT Code 99453 can be billed once each month. If the patient is receiving education, set-up and training on multiple health devices then the provider will need to wait until subsequent months to bill for this service for the remaining health devices. (approx $20)

CPT Code 99454: 16 Days of Monitoring

CPT Code 99454 is used to bill for the collection and continued monitoring of the remote physiologic device(s). This monitoring must occur over a minimum of 16-days of a 30-day period to fulfill Medicare’s RPM requirements. Remote Physiological Monitoring (RPM) services can only be billed once by only one practitioner per 30-day period (even when multiple rpm devices are provided to a patient).(approx. $50)

CPT Code 99091: Collecting and Analyzing Physiologic Data by a Provider

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 with the patient (e.g., phone call or e-mail exchange) to provide medical management and remote monitoring recommendations. CPT code 99091 can be billed once monthly. (approx $54)

CPT Code 99457: 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 as long as the scope of service is met with a patient in a calendar month for 20 to 39 minutes. (approx. $49)

CPT Code 99458: Remote physiologic monitoring (RPM) services for each additional 20 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 99458 is billable along with for CPT 99457 for clinical staff/physician/other qualified professional time as long as the scope of service is met with a patient in a calendar month for each additional 20 minutes up to 2 units. (approx. $40)

Remote patient monitoring solves a lot of problems and helps patients improve their health outcomes with their condition(s) by allowing patients to track conditions that allow remote monitoring daily throughout the year . For starters, RPM allows a provider and/or their clinical staff to be notified at the time when a patient is falling out of the normal range for their health condition. For example, if a patient’s blood pressure is too high or too low, which can cause future issues that may cause hospitalization such as a potential heart attack if the blood pressure is too high or a potential fall that could cause a patient to break a hip if their blood pressure is too low, the digital rpm device can alert their healthcare team as to these changes in blood pressure.

As for a diabetic, RPM gives insights to help both patients and the provider/ clinical staff understand what is causing the spike in blood sugar to identify the potential cause and see if it can be adjusted to try and avoid it from happening again. For example, a patient might not have realized a specific food they were eating was causing their blood glucose to rise and now that they know this they may eliminate or cut down on this specific food to help decrease their chance of having a later onset of a comorbidity due to diabetes. Allowing this virtual continuous glucose monitoring allows a patient to identify and research their triggers instead of waiting 3 months to find out their Hemoglobin A1C. RPM gives patients the exact times within those 3 months that triggered their glucose to rise and helps them to understand what they may need to modify in their lifestyle or eating habits.

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 health outcomes.

Remote Physiologic Monitoring (RPM) codes are for monitoring specific physiologic parameters in between office visits that are critical to improving patient health outcomes.

Both RPM and 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.

However, 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. Whereas, 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.

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 into the health system by the patients themselves.

When physiologic devices are used RPM billing codes can be submitted for health conditions such as: diabetes, hypertension, COPD, obesity and CHF.

Even though RPM and RTM codes do not have a diagnosis requirement, both services need to be medically necessary in order to bill for these services.

A patient qualifies for RPM if he/ she has a condition or acute illness that can be monitored using a remote physiologic monitor that is a FDA- defined medical device to capture and transmit data to their provider or their clinical staff to monitor and give their consent to be monitored utilizing this device.

Patients with these conditions can utilize remote physiologic monitors (RPM):

• Hypertension
• Diabetes
• Obesity
• Congestive Heart Failure (CHF)
• Parkinson’s Disease
• Chronic obstructive pulmonary disease (COPD)
• Sleep apnea
• Asthma
• Renal Failure
• Pulmonary Edema
• COVID-19
• Emphysema
• Hypoglycemia
• Liver Disorders
• Coronary Heart Disease

At times the provider may pay for the initial remote patient monitoring device but is not required to do so, since usually insurance does not pay for this device, and any additional types of monitors are usually the patient’s responsibility. It is important to check with the patient’s insurance to specifically see what the health plan will cover.

No, Medicare usually does not pay for remote patient monitoring equipment. Please check with the patient’s insurance to verify what the health plan will cover.