CPT codes are used to bill Remote Patient Monitoring to the Centers for Medicare and Medicaid Services (CMS) or to private payers. These codes translate into revenue, making Remote Patient Monitoring a sustainable and financially beneficial program for small and medium size medical practices.
In 2021, CMS has expanded the role of Remote Patient Monitoring, including building on CPT codes, expanding the types of clinicians who can perform and bill for Remote Patient Monitoring tasks, and more. Now that CMS has made the program more robust, it’s important to understand how to bill for these services.
The most recent and important changes in Remote Patient Monitoring revolve around CMS clarifying what exactly defines billable services and what qualifies as an Remote Patient Monitoring service in 2021. The most recent CPT code book has defined Remote Patient Monitoring devices as medical devices that automatically collect and transmit patient data for the purpose of treatment and diagnosis. To bill some of these CPT codes, 99453 and 99454 specifically, the Remote Patient Monitoring must consist of at least 16 days worth of data within a 30 day period. While the COVID-19 Public Health Emergency (PHE) is in effect, CMS is allowing fewer than 16 days, but no less than 2 days, worth of data within a 30 day period as long as all requirements are met. The first of these, 99453, “can be billed only once per period of care, defined as “beginning when the remote physiologic monitoring service is initiated and ends with attainment of targeted treatment goals.”
CPT code 99453 compensates providers for any time associated with onboarding and educating a patient while a clinical staff member sets up the necessary Remote Patient Monitoring devices. With 100Plus, providers can earn $24.58 per one time patient under this code.
CPT code 99454 reimburses providers for supplying said patient with a Remote Patient Monitoring device for a 30-day period. 100Plus clients can take in $990 per patient annually using this CPT code.
CPT code 99457 compensates for time spent monitoring physiologic parameters (weight blood pressure, pulse oximetry, and respirator flow rate, for example). This code requires 20 minutes per calendar month and can earn providers $736 per patient annually.
CPT code 99458 is an add-on to code 99457 that reimburses providers for each additional 20 minutes per month of interactive monitoring. This code can provide up to $1,174 per patient annually to medical providers.
CPT code 99091 focuses on data collected within a 30-day period to be analyzed remotely by a physician or medical provider. While this CPT code is still considered valid by the CMS, the codes listed above better represent the various situations that require billing. This code cannot be billed in the same calendar month as 99457 and 99458.
Remote Patient Monitoring services can be provided by companies like 100Plus who deliver, set up, and maintain Remote Patient Monitoring devices. These services can be performed and billed by clinicians and medical providers to CMS by way of CPT codes.
Another major change within Remote Patient Monitoring services, during the public health emergency (PHE), is expansion of the eligible population. For the duration of the PHE medical providers can now conduct Remote Patient Monitoring without an initial new patient visit and evaluation. Remote Patient Monitoring was previously limited to established patients. Due to the current PHE, that rule has been temporarily amended so doctors can use remote communication for face-to-face visits to establish a virtual relationship.
Billing for Remote Patient Monitoring via these CPT codes is a great way for small and medium size medical practices to take in additional income and increase revenue. Remote Patient Monitoring simultaneously mitigates COVID-19 exposure and takes the strain off of facilities during this global health crisis. With the Remote Patient Monitoring and CPT code changes made by CMS, providers can now obtain and
sustain additional automated revenue without any in-person interaction.
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100Plus is the fastest-growing Remote Patient Monitoring provider whose complete, end-to-end Complimentary Concierge™ offering handles the entire implementation of an RPM program and ongoing patient adherence. The services include facilitation of patient outreach, education and enrollment; device set-up and shipping directly to patients; daily adherence to ensure patients are testing; Population Health Management Alerting for at-risk patients; practitioner dashboard and templates to review patient data; automatic bill generation for practitioner payment reconciliation; and full practice and patient support for U.S.-based practices.