Healthcare organizations—and patients—are recognizing telehealth as an effective way of delivering care, especially in response to the digital surge caused by COVID-19. As telehealth becomes a mainstay of patient-centered care, it’s important for healthcare providers to make sure they are getting reimbursed accurately to keep their bottom line in check.
In this cheat sheet, you’ll find a quick and easy guide to the five primary remote patient monitoring CPT codes (RPM CPT codes) that are most relevant to your RPM program.
The 2024 physician fee schedule also added general care management code G0511
for rural health clinic or federally qualified health center (RHC of FQHC) only to
bill for RPM or RTM (not both).
|
Remote Patient Monitoring CPT Codes |
||
|
CPT 99453 |
Initial set-up & patient education on equipment (one-time fee). |
$19.65 |
|
CPT 99454 |
Supply of devices, collection, transmission, and report/summary of services to the clinician. |
$46.83 |
|
CPT 99457 |
Remote physiologic monitoring services by clinical staff/MD/QHCP first 20 cumulative minutes of RPM services over a 30-day period. |
$48.14 |
|
CPT 99458 |
Remote physiologic monitoring services by clinical staff/MD/QHCP for an additional cumulative 20 minutes of RPM services over a 30-day period. |
$38.64 |
|
CPT 99091 |
Collection and interpretation of data by physician or QHCP, 30 minutes. |
$52.71 |
*Pricing amounts vary from area to area and are subject to change.
CPT Code 99453
Description: Remote monitoring of physiologic parameter(s), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
CPT Code 99454 is used for the monthly remote monitoring of physiological parameters, and covers the supply of the devices used by patients to monitor and record physiological data.
CPT Code 99457
Description: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
CPT Code 99457 is designed to provide reimbursement for care coordination and physician-patient interaction. It requires at least 20 minutes of interactive, virtual communication during one calendar month.
CPT Code 99458
Description: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.
CPT Code 99458 covers each additional 20 minutes of interactive, virtual communication provided during one calendar month.
CPT Code 99091
Description: Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional (QHCP), qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.
CPT Code 99091 is a time-based code that covers the collection and interpretation of data by a physician or QHCP and requires a minimum of 30 minutes time spent.
Want to learn more? Download our free, in-depth CPT billing guide today!
CPT Code FAQs
1. What devices are approved for RPM services?
Any device used must meet the FDA’s definition of a “medical device”. The RPM device must digitally (i.e, automatically) upload patient physiologic data (i.e., data cannot be self-recorded or self-reported by the patient). Devices must transmit valid physiologic data that is reasonable and necessary to diagnose or treat and allow understanding of the patient’s health status to develop and manage a plan of treatment. Examples include:
- Blood pressure cuff
- Pulse oximeter
- Heart rate monitor
- Glucometer
- Thermometer
- Weighing scale
- Spirometer
2. Who qualifies for CPT Code 99453 and for CPT Code 99454?
CMS confirmed in the 2021 Final Rule that practitioners may furnish RPM services to remotely collect and analyze physiologic data from patients with acute conditions, as well as patients with chronic conditions.
How many days must RPM services be delivered to be billable?
Billing for CPT code 99453 and CPT code 99454 requires usage of a medical device that digitally collects and transmits 16 or more days of data every 30 days for the billing of these codes. This is referred to as the "16-day RPM requirement." Data collection must occur for at least 16 episode of care days in a 30-day period, NOT calendar month days.
The 16-day data collection rule does not apply to time spent codes 99457 or 99458.What was the 2-day RPM requirement and does it still apply?
A federal waiver issued early in the pandemic permitted providers to deliver and bill for RPM services to those patients with suspected or confirmed cases of COVID-19. The waiver stated that CMS would permit the reporting of RPM services to Medicare for periods of time of fewer than 16 days but no less than two days during the public health emergency (PHE). This became known as Medicare's "2-day RPM requirement."
As of January 1, 2024, the two-day rule during the Public Health Emergency is exhausted.
How often can CPT Codes 99453 and 99454 be reported?
They should be reported only once during a 30-day period. Even when multiple medical devices are provided to a patient, the services associated with all the medical devices can be billed by only one practitioner, only once per patient, per 30-day period, and only when at least 16 days of data have been collected; and that the services must be reasonable and necessary. Based on this rule, each patient must have 16 unique days of readings in said month to qualify for CPT 99453 and CPT 99454
3. Is the cost of the device covered under CPT Code 99453?
No, the cost of purchasing RPM devices is not covered under CPT Code 99453. Since the cost and shipping of devices will not be reimbursed by Medicare, healthcare providers should take into consideration the cost-effectiveness and ROI of the solution before purchasing.
4. Can a third party provider deliver CPT Code 99453 services on behalf of the primary provider?
Yes, CPT codes 99091 and 99457 are reimbursable by Medicaid. We advise checking with your specific private insurers for clarification as reimbursement varies by payers. Partnering with a third party provider that provides patient delivery and set up logistics allows the primary provider to focus on patient care instead.
“Proper billing for telehealth and RPM reimbursement requires precise records for the amount of time spent reviewing patient health data. Through our partnership with HRS, our Client Success Manager is able to pull this information on our behalf and send us detailed reports.”
— Yvette Valentine, Director of Operations, Ohio Living
Get a Better Understanding of What Reimbursement Looks Like for You
We have a host of resources on reimbursement and RPM billing modeled after best practices and established from working with our healthcare partners.
You can reach out to our Revenue Cycle Management team for guidance on how to get or optimize reimbursement for your RPM program. Or, you can try our reimbursement calculator to see what your potential reimbursement might be for your programs.
