How to Bill for Remote Patient Monitoring

Ishan Sharma, Client Success

May 5, 2022

Billing of Remote Patient Monitoring CPT codes has grown 1900% from 2019 - 2021. Here's how to make full use of RPM CPT codes.

Introduction

While remote patient monitoring was gaining popularity over the last decade, it has grown considerably during the COVID-19 pandemic. In fact, remote patient monitoring is the fastest growing area in healthcare with over 1900% growth in just two years. This is supported by Current Procedural Terminology (CPT) Code changes in 2020, which allowed doctors to get reimbursements for implementing and running RPM at their practices.

How to bill for Remote Patient Monitoring

Documentation Required for Billing RPM

There are a few things to note for healthcare providers looking to bill and get reimbursed for RPM services. First, RPM is a program that is billed monthly and patients need to receive a minimum of twenty minutes of service per month to qualify for Medicare reimbursement. This time can be a combination of interactive communications, remote monitoring, and data reporting.

Additionally, RPM services have to be ordered by a physician or qualified healthcare professional. This can include a nurse practitioner, certified nurse specialist, or physician assistant. Some RPM programs may have a care coordinator or nurse conduct the initial review and then consult with a physician for final interpretation and action.

Common CPT Codes

CPT codes for remote patient monitoring align with specific services performed, including:

Initial device setup
Providing care to a patient
Patient daily use of an RPM device.

Initial device setup activities can only be billed once. Daily device use can also only be billed once per month. Finally, daily device use should only be billed on the last calendar day of the month if a patient has taken sixteen daily device readings.

Note: 99454 can be billed every 30 days, while 99457 can be billed every calendar month

Other notes on billing RPM

1. Check if pandemic-era patients qualify

The COVID-19 pandemic has made RPM services available to a much larger group of patients. Due to the risks and restrictions around in-person appointments, CMS waived previous restrictions that limited RPM services to only established patients. Now, providers can offer these services to new patients, as long as previous restrictions continue to be waived.

2. Chronic and acute health patients now qualify

Additionally, remote patient monitoring services can now be offered to patients with both chronic or acute health conditions. This was clarified by the CMS in 2021 and will stay as the rule even after the COVID-19 pandemic subsides.

3. Ensure patients know how to use devices

Finally, for RPM services to work, a patient should be able to communicate with their provider in a virtual environment. They should feel comfortable using the tools and technology necessary to receive RPM services effectively and consult with their provider as needed.