How Reimbursements and Medicare work

Firstly, let’s look at what Reimbursement and CPT codes will a practitioner be able to bill for RPM. So, CMS has clarified that RPM is a process for which each component is billed under a separate CPT code. Also, feel free to review the full CMS Document here, or read our clear summary of what you need to know.

So, The billable components for Remote Patient Monitoring include the following:

  1. Service Initiation – billed under CPT 99453 – remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on the use of equipment.
  2. Data Transmission – billed under CPT 99454 – remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; every 30 days.
  3. Data Analysis and Interpretation – Also, billed under CPT 99091. So, Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/ or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, every 30 days.
  4. Treatment Management Services – Also, billed under CPT 99457. So, 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; initial 20 minutes)and CPT 99458 (additional 20 minutes).

Reimbursement rates

So, Now lets look at what the reimbursement rates are for RPM. Keeping in mind the following. Also, you will find the national payment rates for 2021 for the five RPM codes. Because the assigned RVUs for each CPT code have been adjusted. Also, the conversion factor for 2021 has been adjusted, these rates are generally lower than the 2020 national payment rates.

CPT Code What activity it covers Who can bill for this Rules for Billing Rate
9453 Initial Setup of Device Not Specified; Not Required to be Clinical Staff (Practice Expense Only Code) Billed 1X Per Patient, Only First Month of Reading for 99454 $19.46

99454

Also, Device Supply With Daily Recordings and Programmed Alerts Not Specified; Not Required to be Clinical Staff (Practice Expense Only Code) Billed Each 30 Days, Minimum of 16 Days of Monitoring* $64.15

99457

 

Also, 20 Minutes of Monitoring and Treatment Management That Includes Interactive Communication With the Patient or Caregiver During the Calendar Month
In Indirect General Supervision of Clinical Staff
So, Billed Each Calendar Month $51.54
(Non-Facility Rate)
99458 So, Each Additional 20 Minutes of Monitoring and Treatment Management Services Provided.
In Indirect General Supervision of Clinical Staff
Also, Billed Each Calendar Month $42.22
(Non-Facility Rate)

99091

Also, 30 Minutes of Monitoring Each 30 Days That Does Not Require Interactive Communication So, Performed by Physician, Other Qualified Healthcare Professional (QHCP) or Clinical Staff Also, Billed Each 30 Days $58.38
CMS RPM Reimbursements

Also, For More information contact us to discuss details of how your practice or hospital can benefit from this.

 

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