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.
- 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.