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Medical coding guidelines for Remote Patient Monitoring in 2023

Remote patient Monitoring(RPM) is a system that helps providers monitor or care for patients outside the traditional place of services. It involves the collection and analysis of patient physiologic data used to monitor and develop and manage optimal treatment plans for a chronic and/or acute illness or condition. This system is limited to established patients. It enables providers to monitor and track patients’ physiologic parameters remotely while in their homes and implement changes to the treatment as appropriate.

Let us look into the medical coding guidelines for Remote Patient Monitoring

Five primary Medicare Remote patient Monitoring codes

  • 99453, 99454, 99091, 99457, 99458
  • Considered as E/M services.
  • Can be ordered and billed only by healthcare providers and non-physician practitioners who are eligible to bill Medicare E/M services.

RPM Codes

  • These are not diagnostic tests and cannot be furnished or billed by an Independent Diagnostic Testing Facility.
  • If a more specific code is available to describe the Remote patient Monitoring service, the more specific code should be billed Example – 95250- Continuous glucose monitoring.

Providing patient education and setting up of the device

  • CPT 99453 is billed when the physician or other qualified healthcare professional (QHP) writes an order for RPM services and the practice sets up the equipment and teaches the patient how to use it.
  • The personnel setting up the device may either be contracted or employed by the billing practitioner.
  • RPM vendors can provide the education and set up the device.

CPT 99453

  • Can be billed only the patient monitoring occurs for at least 16 days of the 30-day period.
  • Can be billed by one practitioner per 30-day period.
  • Cannot be reported more than once during a 30-day period.
  • CPT 99453 is billed once per episode of care.
  • Episode of care begins when the Remote patient Monitoring service is initiated and ends with attainment of the established treatment goal.

CPT 99453

  • Date of Service should be the date a device is provided to a patient or when the patient has been trained whichever is later.
  • The POS should be the location of the billing provider’s office.
  • While billing the provider should include
    • Their order for Remote patient Monitoring
    • The chronic and/or the acute condition for which the patient is being treated and monitored
    • The device type that is being used to monitor the patient
    • The date of delivery of the device
    • The date the training was initiated and the date the first vital was captured from the patient.

Medical Devices

  • Must meet the FDA’s definition of a medical device.
  • It does not have to be FDA-cleared or registered.
  • Device must automatically upload the patient’s physiologic data
  • Should not be manually uploaded by the patient.

CPT 99454 – Receiving RPM data

  • Can be billed if the provider supplies the device and the practice receives the Remote patient Monitoring data or alerts (transmission of data from patient’s home to the practitioner)
  • Should receive the data or alerts for at least 16 days of the 30-day period.
  • Can be reported once every 30 days for the duration of the Remote patient Monitoring service.
  • In the first month of service, if the patient generates 16 days of vitals, the provider can bill CPT 99453 and 99454 in the same month.

CPT 99091 – Collection and Analyzing the Psychologic Data

  • Time-based code
  • Billed when the collected and transmitted physiologic data are analyzed by a physician or a QHP, qualified by education, training, licensure/regulation.
  • Includes only professional work and does not include any practice expense (PE)
  • CPT 99091 includes a total time of 40 minutes broken down as:
    • 5 minutes – preservice work (chart review)
    • 30 minutes – intra-service work (data analysis and interpretation or possible phone call to the patient)
    • 5 minutes -post-service work (chart documentation)
  • Minimum of 30 minutes of time is required to bill this code.
  • Do not report if the work is included in an E/M service for the patient.
  • CPT Assistant January 2019 – “if the service described by the code 99091 are provided on the same day the patient presents for an E/M service, these services should be considered as part of the E/M service and should not be reported separately.

Management Services – CPT 99457, 99458

  • CPT 99457 – Frist 20 minutes
  • CPT 99458 – each additional 20 minutes.
  • Considered as care management services.
  • Can be provided by clinical staff under the general supervision of the physician or NPP

CPT 99457, CPT 99458

  • Time-based codes
  • Billed when the analyzed data is used to develop a treatment management plan until the targeted goals of the treatment plan are achieved.
  • Can be provided under the general supervision of the provider or QHP.
  • Billed under the practitioner’s NPI under whose supervision the clinical staff is rendering this service.
  • When the physician or QHP communicates with the patient or caregiver using live interactive communication.
  • If a healthcare professional spends 20 minutes that are qualified for CPT 99457 this can be billed even if the patient has not sent 16 days of data from their device in that month.

Other important guidelines to remember

  • Remote patient Monitoring services can work concurrently with Chronic Care Management (CCM- 99487, 99489, 99490 and G2058), Transition care management (99495, 99496) and Behavioral Health Integration (99484, 99492, 99493, 99494) if the services delivered are separate with no double counting of time for any individual encounter.
  • These services should not be recorded on days where there is a regular Evaluation and Management (E&M) service, domiciliary rest home service (99324, 99328 and 99334-99337) or home services (99341-99345 and 99347- 99350)
  • Time spent on different days or by different care team members in the month can be combined to qualify for the 20 minutes.
  • If two care team members are delivering the service at the same time the time spent by one care team member should be counted.
  • Time spent should be 20 minutes or more.
  • No restrictions are imposed on 99458 in a month so a facility can bill for 2 instances of 20 minutes in a month for 99458 if required. However, there should be only one instance for 99457 in a given month.
  • 99457 and 99458 require “live interactive communication” between the patient and the care team member. This interactive communication can be a Video virtual interaction as well as a text message. The practice should be prepared to provide documentation that supports the time spent.
  • Can be reported once every 30 days for the duration of the service.
  • Time can be counted when the provider or QHP is engaged in interactive communication with the patient along with time providing and coordinating care management services related to the patient’s condition.

The Average National Medicare Payment Amount, according to the 2022 Medicare Fee Schedule

CPT 99453 – $18.48

CPT 99454 – $55.77

CPT 99457 – $50.18

CPT 99458 – $40.84

CPT 99091 – $56.41


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