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Reimbursements

Understanding CPT codes

Over the past several years, the Centers for Medicare and Medicaid Services (CMS) have worked to expand reimbursement codes available for remote patient monitoring (RPM) as a way to continue to help providers respond to the growing shift and demand for virtual care services.

With financial reimbursement available to support remote care, providers can use the below referenced CPT Codes for quick deployment and scaling of RPM programs. These codes provide a financial structure for physicians and qualified medical professionals to be reimbursed for the time spent and the equipment used for patient care delivered remotely. StreamVitals offers:

 

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What are the CPT codes used for Remote Patient Monitoring?

 



Patient Education

CPT code 99453 is a one-time reimbursement for the setup and patient education of RPM equipment.

This code covers the initial setup of devices, training and education on the use of monitoring equipment, and any services necessary to enroll the patient.

 

 



Supply and Provisioning

CPT Code 99454 covers the supply and provisioning of devices used for RPM programs, and the code is billable only once in a 30-day billing period.

Specifically, this code covers the costs associated with the leasing of a home-use medical device or devices to and for the patient.

 

 



Monitoring Data

CPT code 99457 represents a direct monthly reimbursement for remote monitoring of physiologic data in the context of treatment management services. 

To be eligible for reimbursement, the physician, qualified health plan or other the clinical care team must provide RPM services for at least 20 minutes a month.

 

 



Remote Monitoring

CPT Code 99458 is an add-on code for CPT Code 99457 and cannot be billed as a standalone code.

This code can be utilized for each additional 20 minutes of remote monitoring and treatment management services provided.

 

 




Patient Education

CPT code 99453 is a one-time practice expense that reimburses for the setup and patient education for RPM equipment.

This code covers the initial setup of devices, training and education on the use of monitoring equipment, and any services necessary to enroll the patient.

 

 




Supply and Provisioning

CPT Code 99454 covers the supply and provisioning of devices used for RPM programs, and the code is billable only once in a 30-day billing period.

Specifically, this code covers the costs associated with the leasing of a home-use medical device or devices to and for the patient.

 

 




Monitoring Data

CPT code 99457 represents a direct monthly expense for remote monitoring of physiologic data in the context of treatment management services. 

To be eligible for reimbursement, the physician, qualified health plan or other clinical staff members must provide RPM services for at least 20 minutes a month.

 

 




Remote Monitoring

CPT Code 99458 is an add-on code for CPT Code 99457 and cannot be billed as a standalone code.

This code can be utilized for each additional 20 minutes of remote monitoring and treatment management services provided.

 

 

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