Remote Patient Management

What is Remote Patient Management?

RPM devices are wearables that include trackers and sensors that capture and record patient health data outside of your office. Physicians can then use data the devices record to improve how the patient’s chronic disease is managed and to engage the patient in their own care.

What Financial Benefits does RPM offer?

In 2019, CMS will be separating the current CPT code (99091) for patient monitoring into 3 codes. In 2018, 99091 was reimbursed $58 a month. The new codes essentially cover:

1. Initial training on the device (99453 $21 one time); monthly
2. Monthly for the device (99454 $69)
3. 20-minute monthly call (99457 $54)

What are the New Codes?

The new Chronic Care Remote Physiologic Monitoring codes are: CPT code 99453: "Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.” CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

How Much Time is Required to Bill CPT 99457?

At least 20 minutes per calendar month. This differs from CPT 99091, which requires at least 30 minutes per 30-day period. CPT 99457 is much easier to track because it is based on a calendar month, not 30-day periods. This will more easily align with recordkeeping and claims submission, as CPT 99457 is reimbursed on a monthly basis.

Who can Deliver RPM services?

CPT 99457 allows RPM services to be performed by the physician, qualified healthcare professional, or clinical staff. Clinical staff includes, for example, RNs and medical assistants (subject to state law scope of practice and state law supervision requirements). The inclusion of “clinical staff” is the most significant differentiator from CPT 99091, as that code is limited only to “physicians and qualified health care professionals.” All practitioners must practice in accordance with applicable state law and scope of practice laws. The term “other qualified healthcare professionals” used in CPT 99457 is a defined term, and that definition can be found in the CPT Codebook.

Will Medicare Pay for Setting Up the RPM Device and Patient Education?

Yes. CPT 99453 offers separate reimbursement for the initial work associated with onboarding a new patient, setting up the equipment, and patient education on use of the equipment.

Must the Patient be in a Rural Area for RPM Reimbursement?

No, the patient need not be located in a rural area or any specific originating site.