CPT Codes & Billing For Remote Patient Monitoring

CPT Codes & Billing For Remote Patient Monitoring
Dr Josh September 17, 2022 Remote patient Monitoring

Remote patient monitoring and telehealth facilities have become the talk of the town due to their effectiveness and convenience. The COVID-19 pandemic has expedited this digital shift, making telehealth a primary part of patient-centered care. However, healthcare providers must ensure accurate reimbursement to keep their finances and service provision in check.

Billing for remote patient monitoring occurs through Current Procedural Terminology (CPT) codes. These specialized codes determine and categorize the procedural rules and billing rates for treatments, care services, and medical procedures. Although all healthcare providers are aware of the intricacies of CPT codes for billing, it is also pivotal for clients to be aware of them.

Related: 2022 Remote Patient Monitoring CPT Codes

Being aware of the billing codes for telehealth allows the patient and the healthcare provider a good idea of the medical procedures and their expenditure. Knowing your billing codes can also help optimize your medical staff’s working capacity and streamline revenues. Being unaware of these intricacies is likely to risk an obscured outlook and disorganization.

Let us look at the primary CPT remote patient monitoring codes and their most common queries.

CPT Codes for Remote Patient Monitoring

Four primary CPT codes cover remote patient monitoring as of January 2022. These codes are as follows:

  • 99453
  • 99454
  • 99457
  • 99458

Their descriptions and common queries are mentioned ahead.

CPT 99453

CPT 99453 covers the initial virtual monitoring of physiological parameters, including respiratory flow rate, weight, pulse oximetry, and blood pressure. It also includes patient education and set up of the necessary equipment use.

CPT 99454

CPT 99454 covers the initial monitoring of primary physiological parameters, including blood pressure, respiratory flow rate, pulse oximetry, and weight. It also covers the supply of one or more medical devices with daily recordings and pre-programmed alert transmission for thirty days each.

CPT 99457

CPT 99457 covers the remote physiological monitoring treatment and management services offered by a physician, clinical staff members, or any other qualified healthcare professional in a calendar month. These services include interactive communication with the caregiver or patient during the month, typically for 20 minutes.

CPT 99458

CPT 99458 supplements CPT 99457. It also covers remote physiological monitoring treatment and management services provided by a physician, a clinical staff, or any other qualified healthcare professional in a calendar month. However, it covers the interactive communication with a caregiver or patient for an additional twenty minutes.

Things You Should Know About Remote Patient Monitoring CPT Codes

A healthcare provider can bill 99454 only once per patient every thirty days. This is regardless of the number of medical devices used.

Related: What Is The Future Of Remote Patient Monitoring?

Remote patient monitoring under 99457 can only be performed by clinical staff, qualified healthcare professionals (QCHP), or a billing physician. Additionally, it necessitates a minimum of 20 minutes of logged management time per month.

A healthcare practice can add two instances of 99458 per month after 99457 has been billed: once at 40 and 60 minutes, respectively.

  • A healthcare provider can bill through these RPM codes during:
  • The same transitional care management (TCM) through CPT codes 99495-99496
  • Chronic care management (CCM) through CPT codes 99487-99490 
  • Behavioral health integration (BHI) through CPT codes 99484, 99492-99494.

Who is eligible for CPT Code 99453 and CPT Code 99454?

The 2021 Final Rule confirmed that healthcare professionals could provide RPM services for a virtual collection and analysis of patient physiological data with acute and chronic conditions.

When are RPM services billable during the pandemic?

The answer to this common query was 16 days before the pandemic. However, a federal waiver was issued in the early days after the COVID-19 breakout, allowing healthcare providers to provide and bill for medical services to patients with a confirmed or suspected case of COVID-19. The waiver allowed medical providers to report RPM services for periods less than 16 days but no less than two days during a public health emergency (PHE). This is now known as the “2-day RPM requirement.”

Related: What Are The Essential RPM CPT Codes?

However, it is crucial to note that billing for CPT 99454 and CPT 99453 requires a medical device that digitally collects and transmits 16 or more days of data every 30 days. This is known as the “16-day RPM requirement.”

The 2-day RPM requirement cannot be applied to all patients during the PHE. It was clarified in early 2021 that the two-day RPM requirement could be applied to patients with a confirmed or suspected diagnosis of COVID-19.

How many times can CPT Codes 99453 and 99454 be reported?

CPT codes 99453 and 99454 can be reported just once every 30 days. The services related to all medical devices, if multiple devices are provided to a patient, are billed by a single practitioner once per patient, every 30 days. Additionally, it is done only when a minimum of 16 days of data has been collected for reasonable and necessary medical services. Therefore, patients can qualify for CPT 99453 and CPT 99454 if they have 16 unique days of readings in a particular month.

Does the CPT Code 99453 cover the cost of the medical device?

No, CPT Code 99453 does not cover purchasing a medical device. Since healthcare insurance does not cover the shipping and cost of a device, healthcare providers must look into the healthcare solution’s return on investment and cost-effectiveness.

Can a third-party provider deliver CPT Code 99453 services on behalf of the primary provider?

Yes, CPT codes 99457 and 99091 can be delivered by a third-party provider on behalf of a primary healthcare provider. However, checking with your private insurers for clarification is advisable, as reimbursement may differ for different payers.

If you are looking to attain top-notch remote patient monitoring services with seamless billing, SmartClinix is the place for you. Head over to SmartClinix to know more!  

Dr Josh

Dr. Josh is a physician who's helping spread the knowledge about Telehealth and its advantages. At SmartClinix, he's providing his expertise and knowledge in the form of engaging articles on various health & tech related topics.

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