Guide to RPM Codes (2024): 99453, 99454, 99457, 99458, 99091
Healthcare organizations are incorporating telehealth and remote patient monitoring (RPM) technology into their routine practice. Thus, they need to get accurately reimbursed for their services. Medical reimbursements, in general, are connected to Current Procedural Terminology codes (CPT codes).
These codes include the following RPM CPT codes:
These codes specify rules and billing rates for the provided procedures, treatments, and care services.
If you are a healthcare provider, you are mostly aware of standard codes.
However, remote patient monitoring is relatively new, so you might not be aware of remote patient monitoring CPT codes.
Knowing the CPT codes for RPM can benefit both the patient and the doctor, as it lets both know what to expect in terms of how much they are paying and getting reimbursed, respectively.
Understanding the medical billing process and its codes is very important, as it helps optimize the practice’s revenues and the staff’s capacity.
Our team at SmartClinix has gathered information from regulations, standards, policies, and literature reviews. We have condensed our findings to produce an article with all the information you need to better understand CPT codes for RPM.
How does Remote Patient Monitoring Work?
Before diving into how CPT codes function, we must first look at how RPM functions as technology in a medical setting.
Remote patient monitoring is a general option established by Medicare. RPM involves multiple digital devices which can track and record patient data when the patient is at home.
The technology can transmit the data directly to the doctor. This means that healthcare groups, including doctors and hospital teams, can collect and analyze patient data between normal routine physician visits.
Patients insured with Medicare B are eligible to get reimbursed for up to 80% of RPM-related care. Patients must receive 20 or more minutes of RPM care per month for Medicare to offer any reimbursements to them.
Medical providers, on average, receive $52 for 20 minutes of RPM services per month. They also receive an additional $56 if they provide daily services because the patient uses the RPM devices daily.
Billing for Remote Patient Monitoring
Submitting a claim through the Centers for Medicare and Medicaid Services (CMS) can be a confusing and intimidating process.
This is why we have made a small list of everything you would need to submit a claim through CMS:
- CPT codes for each program you manage for your patient
- ICD-10 codes
- Care Manager name, date of service, place of service, and provider name.
You must verify that you meet the CMS requirements for each patient each month and submit claims to CMS every month. After submitting these claims, you need to send the patient an invoice with all the relevant payment information. Lastly, you must make certain that the codes are entered perfectly.
CPT Codes for Remote Patient Monitoring (2024)
CPT codes for RPM must correspond to an exact activity, whether providing a service or setting up the technology. The different codes represent different types of services and setups and thus maintain different reimbursement rates. We have described all the relevant RPM CPT Codes below.
CPT Code 99453
This code is for the initial setup and patient education on the equipment. It is a one-time fee of $19.04.
One should only be billed once per month per device. For example, if the patient is given two or more devices for their remote patient monitoring, then they can only be billed for one of those devices in that month. The 2nd device should be billed in the next month, and so on.
CPT Code 99454
CPT Code 99454 covers the supply of the RPM devices used by the patient to monitor and record their physiological information.
It is also used to bill for the monthly remote monitoring of physiological parameters of the services.
CPT Code 99457
Patients can have virtual meetings with their physicians much like physical ones. CPT Code 99457 provides reimbursements for care coordination and physician-patient interactions where they meet virtually.
For the physician-parent interaction to apply, the interaction must be at least 20 minutes of interactive, virtual communication during one month.
Thus, idle time monitoring the patient’s vitals without effectively talking to the patient is not included in this.
For example, if there is an appointment-styled virtual meeting through RPM that lasts more than 20 minutes, it would count.
CPT Code 99458
CPT Code 99458 is similar to CPT Code 99457 in that it covers patient-physician interactions that have a duration longer than 20 minutes and are interactive.
Where it differs is that CPT Code 99458 covers any additional 20-minute intervals of interactive, virtual communication per one calendar month, whereas CPT Code 99457 covers the initial 20-minute interval.
CPT Code 99091
RPM technologies don’t just record data. They collect it and send it to healthcare professionals for interpretation. CPT Code 99091 is responsible for the billing of this service as it covers the collection and interpretation of physiologic data that is digitally stored/transmitted by the patient to the physician or other healthcare professional.
This, much like the other mentioned codes, is time sensitive as well, and it requires a minimum of 30 minutes spent, per month, on the collection and interpretation of data by a physician or healthcare professional.
This cannot just be interpreted by any doctor. It needs to be a certified healthcare professional who is qualified by education, training, and licenses where applicable.
General Questions Regarding RPM and CPT Codes
Due to the complicated nature of medicine, situations can arise that you might have difficulty sorting into a code. This is where we try to answer some of these problems.
The RPM Devices must be FDA-Approved. The device must be able to automatically upload patient physiological data to the EHR Software.
If the patient needs to self-record the data, it cannot be considered an RPM device. The device must also provide relevant medical information about the patient’s health status that helps the medical team develop a treatment plan.
Examples of such devices include blood pressure cuffs, glucometers, pulse oximeters, thermometers, and scales.
The RPM device cost is not covered under CPT Code 99453. This means that Medicare will not reimburse the cost of the device or the cost of shipping. Due to this, healthcare providers should consider the cost-effectiveness of the RPM device.
At SmartClinix, each device costs around $125
A third party can deliver RPM devices and services on behalf of the primary care provider. This means that CPT Codes 99091 and 99457 are applicable, and the ordeal will be reimbursable by Medicare.
This can prove very beneficial as it allows the primary care physician to focus on providing the best form of care by leaving the logistical aspects to the third party.
RPM in Rural Areas
Despite the benefits of RPM for hospitals in rural areas, Medicare has not yet included them in this program. Thus, RPM CPT Codes are not applicable in these healthcare organizations. RPM can still be used, but it must be billed under a more general CPT code.
Related: What is Remote Cardiac Monitoring?
In most cases, it is billed in Chronic Care Management (CCM), often under CPT Code G0511. This code pays $76.94 for 20 minutes of services per patient per month. The code was created for general care management, and CMS has purposefully kept its perimeters broad so that medical care like this can be provided, which would otherwise not be covered by any CPT code. It is important to note that this code can only be applied once a month per patient.
What Can You Do?
Understanding billing codes for RPM devices is essential if your healthcare organization uses telehealth technology. To optimize the care given in your medical practice, sign up with SmartClinix.
SmartClinix can provide you with RPM devices and the services to initialize them so that you can receive patient data and give them quality care.
We even provide a 24/7 technical, medical billing services, and support team for our RPM devices so that we may help you through any problems that arise.
In addition, we even arrange for the RPM devices to be delivered to patients’ homes. SmartClinix has a team of renowned physicians and billing experts. Let us worry about the logistics of the devices and their billing so that you can focus on what matters: providing excellent quality care.
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.