A Comprehensive RPM Billing Guide to Understand the Reimbursement Process
The RPM billing guidelines outline reimbursement process for Remote Patient Monitoring (RPM) services. It includes documentation, coding, and submission requirements for accurate claims.
Understanding RPM’s eligibility criteria, CPT codes, and reimbursement rates is very important. Thorough documentation of patient consent, medical needs, and tracking data or information plays a vital role for successful claims. Following the provider’s guidelines and staying updated on changes ensures a seamless reimbursement process.
CPT Codes for Remote Physiologic Monitoring (RPM Billing)
Understanding the appropriate RPM billing codes is important for ensuring accurate coding, documentation, RPM medical billing and ultimately, successful reimbursement.
CPT Code 99453 ($20)
Providing Set-up and Training of device for the patient
- All auxiliary personnel (including clinical staff and non-clinical) may provide education to patients.
- All auxiliary personnel (including clinical staff and non-clinical) may also provide set up of the remote physiologic device.
- Healthcare personnel can be either contracted or employed by the billing practitioner. RPM equipment vendors or RPM care management services vendors can also provide the education and set-up of the monitoring device.
- The remote monitoring reimbursement rate for this code is approximately $19.32.
CPT Code 99454 ($50)
16 Days of Patient Monitoring
- Bills for the collection and continuous monitoring of the RPM device(s).
- Daily monitoring must occur at least 16-days within the last 30 days to fulfill Medicare requirements.
- Only one practitioner can bill RPM services per 30-day period.
- Can only report this code once per patient per 30-day period, regardless of multiple medical monitoring devices used.
- The remote patient monitoring reimbursement for this code is approximately $50.15.
CPT Code 99457 ($50)
Remote physiologic monitoring (RPM) services for 20 to 39 minutes
- The clinical staff collects, reviews, interprets and reports remote physiologic monitoring patient data.
- The system digitally collects and manages physiologic data under a patient’s treatment plan.
- Healthcare providers use CPT code 99457 to bill for 20-39 minutes of time spent with a patient in a calendar month.
- The reimbursement rate is approximately $51.54.
CPT Code 99458 ($40)
Remote physiologic monitoring (RPM) services for each additional 20 to 39 minute interval
- The physician or QHP collects, reviews, interprets and reports remote physiologic monitoring data.
- The system digitally collects and manages physiologic data under a patient’s treatment plan.
- Bill CPT Code 99458 along with CPT 99457 for additional time spent with a patient.
- Healthcare providers use CPT code 99458 to bill for 20-39 minutes of time spent with a patient in a calendar month. This is in addition to 99457, the first 20-39 minute interval.
- The physician or QHP can spend extra time with a patient in a month, up to 2 units. This is for every 20 minutes after billing code 99457.
- Clinical staff include medical assistants, LPNs, LVNs, RNs, and BSNs.
- The reimbursement rate is approximately $40.00.
CPT Code 99091 ($55)
Collecting and Analyzing Physiologic Data by a provider
- Billed by a physician or qualified healthcare professional (QHP) for a minimum of 30 minutes of time.
- The physician or QHP collects, reviews, interprets and reports remote physiologic monitoring data. The patient, and/or caregiver, or other QHP digitally stores and/or transmits this data to the physician.
- At least one communication by phone or email with the patient to provide medical management and monitoring recommendations.
- Providers bill remote monitoring CPT code 99091 only once per calendar month.
- The remote monitoring service reimbursement rate for this code is approximately $55.00.
Tips for Successful RPM Billing of Remote Physiologic Monitoring
To successfully bill Remote Physiologic Monitoring (RPM) services, ensure accurate coding with correct CPT and ICD-10 codes. Comprehensive documentation of patient consent or agreement, medical needs, and monitoring data, while complying with insurance provider guidelines, is also essential.
If you want to get reimbursed for providing set-up and training of a device to a patient, remember that you can only bill for one device per month when using CPT Code 99453.
When billing CPT Code 99454 this is for 16 days of readings. If you provide a patient with several devices, it doesn’t matter how many readings they submit in a day. You can consider that day’s readings as one of the 16 days of readings.
Also, it is helpful to bill CPT Code 99454 once the 16 day readings are met instead of waiting until the end of the 30 day period. This recommendation is in place help make sure you receive payment in case another provider tries to bill for these services.
To ensure you receive the maximum healthcare reimbursement for clinical staff or provider time, it is advisable to wait until the month’s end and utilize all the relevant RPM CPT codes when billing.
Additionally, it is helpful to utilize a remote physiologic monitoring platform to document your work, that have a real time bi-directional interface with your EHR and practice management software that can automatically drop for medical claims processing to your billing system to easily bill, eliminate any keying errors and be time efficient for your billing staff.
Conclusion
Remote Physiologic Monitoring (RPM) services provide an innovative healthcare approach.
It facilitates improved patient management, proactive interventions, and better patient outcomes. Using technology in patient care allows constant monitoring and early detection of problems, improving the relationship between patients and healthcare providers.
RPM and CCM services change healthcare by offering personalized and efficient solutions that empower patients and healthcare professionals.
Remote health monitoring is transforming healthcare delivery and care. Embracing RPM services makes a positive step towards a more connected, accessible, and patient-centered healthcare landscape.
