Remote Patient Monitoring Reimbursement
Remote Patient Monitoring is covered by both Medicare and most private insurance companies and reimbursement rates are typically higher than telehealth and chronic care management. Our typical client achieves a 4.2x return on investment when implementing our Remote Patient Monitoring platform. Providers will have the patient data they need to deliver better treatment to patients, including real time alerts to changes in patient outcomes. RPM tools result in better outcomes - for your patients and your business.
Frequently Asked Questions
CPT Code 99457 allows for reimbursement for time spent by the billing physician, a qualified healthcare professional (“QHCP”), or clinical staff. All practitioners must practice in accordance with applicable state law and scope of practice laws.
The code requires the physician, QHCP, or clinical staff to spend at least 20 minutes per calendar month providing RPM services to a particular patient in order to receive reimbursement.
Approximate reimbursement amounts for each of the codes are as follows:
99453: $19.19 one time per episode of care*
99454: $63.16 every month
99457: $50.94 every month
99458: $41.17 every month if applicable
*NOTE: Amounts listed are approximate values only; reimbursement varies among MAC localities. Contact your local MAC to determine reimbursement amounts in your region.
The Remote Patient monitoring codes are not subject to the same restrictions that currently govern reimbursement of telehealth services under Medicare. Specifically, reimbursement for RPM services is not limited by geography to rural or medically underserved areas, nor is there any “originating site” requirement for RPM services. RPM services can be provided anywhere the patient is located, including at the patient’s home, or while out and about.
Private payers may reimburse for RPM services; however, they are not required to do so. It is important to note that private payers that do reimburse for RPM services may have different requirements for billing. Practitioners should check with the commercial payers in their region to determine whether services are reimbursable and what requirements must be met for billing.
Yes, for Medicare beneficiaries. As with other Medicare Part B services, RPM services are statutorily subject to a 20% beneficiary copay. With very limited exceptions, practices may not choose to waive the Medicare copay. Private payers may establish their own copays or may choose not to require a patient copay.
No. Practices should simply ensure that all requirements for each code are met (e.g. documenting patient consent for RPM services) and follow their current standard billing practices in submitting claims.
No. A practitioner may recommend RPM services for any patient whom s/he deems may benefit from some form of remote patient monitoring through improvements in care planning and treatments.
CPT Codes 99457 and 99091 are similar, but they differ in some important ways. CPT Code 99091 requires an aggregate of 30 minutes of time by a physician or QHCP during a 30-day time period, while CPT Code 99457 requires an aggregate of 20 minutes of time spent by clinical staff, physicians, or QHCPs during a calendar month. In addition, CPT Code 99457 requires live, interactive communication between the individual performing the services and the patient. A billing practitioner should carefully review the requirements for each and use his/her professional judgment to determine which code the provided services should fall under.
No. According to the CPT Code Manual, CPT Codes 99091 and 99457 cannot be billed for the same patient within 30 days of each other.
CMS does not set forth in the Final Rule a specific list of practitioners that are considered “Qualified Health Care Professionals” for purposes of these codes. The code descriptor for CPT Code 99091 references a qualified health care professional as “qualified by education, training, licensure/regulation (when applicable),” and this is the definition included in the American Medical Association’s CPT Manual. The AMA has indicated that the definition is drafted as intentionally broad so as to allow flexibility between payers, providers and regulatory agencies alike to determine the appropriate policies. When in doubt, consult your local Medicare Administrative Contractor (“MAC”).
CPT Code 99454 can only be billed once per patient each 30 days, regardless of whether the patient is using one device or multiple devices. Therefore, if a glucometer, a weight scale, and a blood pressure cuff are all provided to a patient for use in RPM and the devices meet all of the requirements for billing CPT Code 99454, the code could still only be billed once each 30 days for that patient.