Skip to main content

RPM - Remote Physiologic Monitoring

Remote physiologic monitoring (RPM) technology comes in various devices that monitor glucose levels, BP, weight management, sleep patterns, heart rate, vital signs, and many other types of patient data.

RPM allows patients to be involved in their own care by giving them access to their health data in real-time.

For providing RPM services to the patients and staff time spent monitoring the respective beneficiary. These actions are billable through four CPT codes,
  • 99453 - Initial set up and patient education
  • 99454 - Supply of devices and collection, transmission, and summary of services
  • 99457 - First 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP
  • 99458 - For an additional 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP

Initial Set-Up & Patient Education - CPT 99453

  • It is reported for each episode of care.
    • An episode of care is defined as beginning when the remote monitoring physiologic service is initiated and ends with the attainment of targeted treatment goals.
  • CPT 99453 should not be reported, “If monitoring is less than 16 days.” If, for example, a patient receives and is educated on the device, but no data is transmitted by the device, one could not bill for CPT 99453.

Supply of Device - CPT 99454

  • It is used to report the supply of the device for daily recording or programmed alert transmissions over a 30-day period provided monitoring occurs at least 16 days during the 30-day period.
  • CPT 99453 & 99454 should not be reported “when these services are included in other codes for the duration of time of the physiologic monitoring service" (e.g., 95250 for continuous glucose monitoring requires a minimum of 72 hours of monitoring).

Monitoring & treatment Management services - CPT 99457 & 99458

  • It requires live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month.
  • Can be billed once in 30 days.
  • Time spent by clinical staff may be counted toward the 20 minutes only if services are furnished under direct supervision.

CPT Guidelines

  • Time of fewer than 20 minutes during a calendar month cannot be billed with CPT 99457.
  • Time over 20 minutes in one month cannot be carried forward to the next month.
  • 99457 may be reported during the same service period as chronic care management services (99487, 99489, 99490), transitional care management services (99495, 99496), and behavioral health integration services (99484, 99492, 99493, 99494). 
  • However, time spent performing these services should remain separate and no time should be counted toward the required time for both services in a single month.
  • Report CPT 99457 one time regardless of the number of physiologic monitoring modalities performed in a given calendar month.
  • “live interactive communication,” means a face-to-face visit, an interactive video conference (e.g., FaceTime), or a conversation by telephone or text message would be sufficient. A record of such communication should be included within the documentation for the service.

RPM Billing Requirements

  • The place of service would be the location at which the billing physician maintains his or her practice (i.e., physician office vs. hospital outpatient department).
  • A beneficiary may have two monitoring devices with one supplied by the physician monitoring one chronic condition and one by another physician monitoring another condition, and both physicians would be eligible for payment.

Popular posts from this blog

Usage of CPT Index - Instructions

The alphabetic index is not a substitute for the main text of the CPT codebook. Even if only one code is present, the coder must refer to the main term to ensure that the code is selected accurately and correctly to identify the services rendered. Main Terms The index is organized by main terms. Each main term can stand alone or can be followed by up to three modifying terms. There are four primary classes of main entries, Procedures or Services - E.g, Scopic, Anastomosis, Splint, Opening Organ or Other Anatomical Site - E.g, Knee, Arm, Ear, Tibia, Colon Conditions - E.g, Abscess, Entropion, Tetralogy of Fallot. Synonyms, Eponyms, and Abbreviations. - ECG, EEG, PET, Brock Operations, Clagett Procdures Modifying Terms The main term may be followed by up to three indented terms that modify the terms they follow. EG. The main term "Endoscopy" is subdivided by the anatomical sites in which the procedure is used. And within these anatomical sites, the specific purpose of the pr

Additional Information About Modifiers

Sequencing of modifiers  How can that be if the modifiers used were accurate?  There is an order to reporting modifiers and there are three categories that modifier usage fall under:  1. Pricing  Pricing modifiers are always sequenced “before” payment modifiers and/or location modifiers.   The only exception to this rule is when a global surgery package is involved.  For example, you would code modifier 58 first and modifier 82 second in a global surgery.  A few examples of pricing modifiers are: 22, 26, 50, 52, 53, 62, 80, and P1-P6.   2. Payment   Payment modifiers alert the insurance carrier that there is a special situation within the claim  Some examples of payment modifiers would be: 24, 25, 51, 57, 58, 59, 76, and 78.  3. Location  Examples of location modifiers are: E1-E4, FA, F1-F9, LC, LD, LT, RT, RC, TA, and T1-T9.  The general order of sequencing modifiers is ( 1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”.  If you code

Evaluation and Management (E/M) Services - Domiciliary or Rest Home Environment

Domiciliary, Rest Home, or Custodial Care Services CPT codes 99324 - 99337 Domiciliary, Rest Home (e.g. Boarding Home), or Custodial Care Services, are used to report E/M services to individuals residing in a facility which provides room, board, and other personal assistance services, generally on a long-term basis.  These codes are also used to report E/M services in an assisted living facility. The facility’s services do not include a medical component. A home or domiciliary visit includes a patient History, Physical Examination and Medical Decision Making in various levels depending upon a patient’s needs and diagnosis.  The visits may also be performed as counseling and/or coordination of car, when medically necessary outside the office environment and are an integral part of a continuous of the patient's care.  The patients seen may have chronic conditions, may be disabled, either physically or mentally, making access to a traditional office visit very difficult, or may have l