CPT Codes for Remote Patient Monitoring
There are three CPT codes that are commonly used when billing for remote patient monitoring (RPM).
These codes help practitioners get reimbursed for the time and effort involved in device set up and monitoring.
CPT 99454: Frequently Asked Questions
CPT Code 99454 is the billing code for supplying and monitoring patients RPM devices. The code reimburses providers for the continuous supply of devices and remote monitoring. This code can be billed monthly, but only once per patient, per month, regardless of how many devices the patient has. CPT Code 99454 comes with a unique set of rules and qualifications broken down here in this comprehensive guide.
CPT Code 99454 services cover continuous device supply and patient monitoring. This code also covers costs associated with leasing an RPM device.
All remote patients covered by Medicare qualify for CPT Code 99454. The expansion of the remote patient population that came with COVID-19 pandemic, allowed even more Medicare patients to qualify for these CPT codes.
The major devices used for code 99454 are:
- Blood Pressure Cuff
- Pulse Oximeter
- Blood Glucose Monitor
- Digital Weight Scale
For billing, CPT Code 99454 covers the monthly servicing costs of devices and treatment services.
Under CPT 99454, clinicians and physicians can be reimbursed $62.80 for supplying devices and monitoring.
Providers can get paid for their remote monitoring work by using the right CPT Codes. For CPT Code 99454, monthly billing for supplying devices and monitoring patients, the primary physician or clinician of the patient must order the devices. The primary physician or clinician also needs to provide invoices for the cost of the devices and services related to the devices. CPT Code 99454 requires 16 days of patient data readings during a 30-day billing period.
A single patient can have multiple RPM devices under the CPT Code 99454, but providers can only bill once per patient per 30 days period, and only when at least 16 days of patient data has been recorded, even when multiple devices are supplied to a single patient.
The Centers for Medicare and Medicaid Services has not stated the specific types of technology or devices that apply to CPT Code 95454 in the most recent CMS-1693-F final rule. The CMS has stated that the device must be a “medical device as defined by the FDA.” Medicare does not require the device to be “approved” or “cleared” by the FDA, but specific providers may require FDA approval for RPM devices.
The work for each RPM service must be ordered by the patient’s physician or clinician and they must be monitored for at least 16 days before providers can bill for CPT Code 99454.
CPT Code 99454 can be billed every 30 days.
Use CPT Code 99454 to keep patients monitored and providers paid. With no hassle patient onboarding, no upfront costs, and full support for physicians, clinicians, and patients alike, 100Plus makes RPM easy.
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CPT 99458: Frequently Asked Questions
CPT Code 99458 is a remote monitoring billing code used to reimburse practices for remote care services through Medicare. Code 99458 varies slightly from other codes as it is considered an add-on to CPT Code 99457, rather than being considered a standalone code.
To qualify for reimbursement for Code 99458, physicians must first meet the 20 minutes of service requirement for Code 99457, then bill for each following additional 20 minutes of service. This code helps to provide for practices who support remote patients with extra care and additional services by allowing practices to bill for services provided beyond the required 20 minutes.
RPM companies such as 100Plus make interactive remote patient care necessary for Medicare reimbursement easy and accessible.
Similar to CPT Code 99457, Code 99458 requires interactive communication in order to be added on to reimbursements. This interactive communication is defined as “ a conversation occurring in real time that includes synchronous, two-way interactions that can be enhanced with video or other kinds of data.” Additionally, the CMS clarified that the 20 minutes of service time required to bill for both 99457 and 99458 “should include care management services and synchronous, real-time interactions.” Therefore making it clear that, while interactive communication contributes to the required 20 minutes, it is not the only activity that should be included in the total time as overall care management can contribute as well.
All Medicare patients with chronic conditions such as diabetes, obesity, CHF, and hypertension qualify for CPT Code 99458. The expansion of the remote patient population that came with COVID-19 pandemic, allowed even more Medicare patients to qualify for these CPT codes. In response to the public health crisis, the CMS finalized a series of CPT codes, including Code 99458, in order to effectively cover Medicare patients in need of remote care.
The major devices used for code 99458 are:
- Blood Pressure Cuff
- Pulse Oximeter
- Blood Glucose Monitor
- Digital Weight Scale
Since CPT Code 99458 is only an add-on code for CPT Code 99457, it can’t cover the cost of the device on its own. Patients that qualify for the original CPT Code 99457, however, are covered by said code for treatment services and device cost.
Medicare reimburses approximately $42.00 for CPT Code 99458. This CPT code in particular is for additional time spent with a patient and can be billed only after practices meet the requirements for CPT Code 99457.
In order to get reimbursed for CPT Code 99458, clinical staff or other qualified health care professionals must use the results collected by remote monitoring services in order to deliver a personal treatment plan. To get reimbursed for Code 99458, clinicians must first complete the requirements and submit for reimbursement under CPT Code 99457, as Code 99458 is only an add-on to Code 99457. All reimbursement codes are submitted directly to Medicare and can be billed in increments of 20 minutes. These services can be supplied by qualified healthcare providers if they are under the general supervision of the primary physician.
Under Code 99458, incidental to Code 99457, RPM services can be delivered by any qualified healthcare professional if the services are completed under the general supervision of the primary physician. Therefore, it is not the direct physician who is entirely responsible for providing services or submitting reimbursement claims, as the work can also be performed by other qualified employees within a practice.
CPT Code 99548 does not currently have any limitations regarding the frequency with which it can be billed per month. Providers can bill under CPT Code 99458 for each additional 20 minutes of services provided if those 20 minutes meet the requirements for reimbursement.
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CPT 99453: Frequently Asked Questions
CPT Code 99453 is the billing code for setting up patients with RPM devices. It reimburses providers for the time it takes to set-up devices and educate patients on how to use their new at home monitors. This code is different from some of the other CPT codes because it is used only once for every patient rather than a monthly or annual billing code. CPT Code 99543 comes with its own set of rules and qualifications that are mapped out here in this comprehensive guide.
CPT Code 99453 is a billing code that compensates providers for onboarding, initial device set-up, and patient education while setting up RPM devices. With 100Plus, providers can earn $24.58 per one time patient under this code.
The services required for CPT 99453 as specified by Medicare guidelines are: the initial set-up and initial patient education on use of equipment. Medicare additionally requires that a member of the clinical staff or under the supervision of the primary physician spend time helping the patient set up and become comfortable with device use.
The eligible population for RPM has grown significantly in the past couple of years, this includes patients who now qualify for the CPT Code 99453. Remote monitoring was previously limited to Medicare patients with chronic conditions who were already established with their primary physicians and clinicians, thus preventing new patients from being added to the program without an initial in-person visit. Due to the current public health emergency, these initial in-person visits are no longer available to some, thus doctors can now use remote communication for first time visits to establish a virtual relationship with Medicare patients suffering from chronic conditions.
The major devices used for code 99453 are:
- Blood Pressure Cuff
- Pulse Oximeter
- Blood Glucose Monitor
- Digital Weight Scale
For billing, CPT Code 99453 will only cover the cost of the time spent setting up the device and educating the patient on device use. Cost and shipping of RPM devices will not be reimbursed.
As of this year, 2021, the average amount that Medicare will reimburse providers for CPT Code 99453 is $19.90.
CPT Code 99453 is unique in that it is an initial billing code that can only be billed once per patient during the device set-up period. Other codes, such as CPT 99454 and CPT 99457 can be billed monthly for continuous service costs, device supply, and treatment services.
Providers can get paid for their remote monitoring work by using CPT Codes. For CPT Code 99453, billing for the initial set-up of RPM, the primary physician or clinician of the patient must order the set-up. Providers can then bill for this code once per patient. CPT Code 99453 requires 16 days of patient data readings during a 30-day billing period.
Yes, a third-party RPM partner can deliver CPT 99453 services on behalf of the practice, so long as it is supervised by the primary provider. These third-party partners can educate patients on device set-up and use. Utilizing a third-party partner that specializes in remote monitoring, like 100Plus, can alleviate stress from and help physicians and clinicians to run crucial and efficient RPM services.
Yes, a single patient can have multiple RPM devices under the CPT Code 99453, but providers can only bill for the set-up of one device. This code is used to bill for the initial set-up and education of the patient regardless of the number of devices they are using.
As of 2021, the Physicians Fee Schedule Final Rule has clarified which RPM devices are acceptable medical equipment for Medicare patients. Devices for CPT Code 99453, however, do not need to be specifically FDA-approved. Instead, Medicare specifies that the devices meet the FDA’s definition of a medical device as described in Section 201(h) of the Federal, Food, Drug and Cosmetic Act.
By this standard, the device must:
- Automatically upload patient data to primary physicians and clinicians
- Be relevant to the treatment plan for the patient’s condition
- Collect and transmit data in an accurate and reliable manner
The work for each remote monitoring service must be ordered by the patient’s primary physician or clinician and they must be monitored for at least 16 days before providers can bill for CPT code 99453.
Use CPT Codes like 99453 to keep your patients monitored and providers paid. With no hassle patient onboarding, no upfront costs, and full support for physicians, clinicians, and patients alike, 100Plus makes RPM easy.
Find Out Your Estimated Reimbursement
Talk to an RPM specialist today and get an estimate for Medicare reimbursement in your area. With 100Plus you can deliver exceptional care for your patients beyond the four walls of the office.