What Are The Essential RPM CPT Codes?

Remote patient monitoring (RPM) is an essential branch, robust augmentation, and significant extension of telehealth and has revolutionized the health industry with its numerous benefits.

The role of RPM in minimizing the danger of Covid-19 has undoubtedly been substantial, and thus it has emerged as a beneficial substitute for in-person medical checkups. Remote patient monitoring has now become a household name and allows medical professionals to manage patients with chronic conditions right from the comfort of their homes.

However, specific RPM CPT codes are commonly used to incentivize clinicians and promote remote patient monitoring. These rpm billing codes include CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 9909. But what are these codes, and how do they work? Let’s get right into it.

Related: How Can Remote Patient Monitoring Increase Your Revenue?

What are CPT codes?

CPT codes are five digit numerical codes without a decimal mark, but some have one letter and four numbers as well. These codes are numbers that are assigned to each task and service provided by a healthcare provider. They are used to bill and track medical services and are assigned differently to different actions.

Current Procedural Terminology codes include surgical, medical, and diagnostic services, and insurers utilize these codes to determine the amount they are required to pay a provider.
CPT codes are the same for everyone everywhere to ensure uniformity. Some may be used frequently, whereas others are seldom used. For example, the codes 99214 and 99213 are general checkups and are thus often used.

However, these codes do not depict a universal definition of health services for all. They also do not ensure that different healthcare providers get reimbursed for their services in the same pre-decided amount: such intricacies are typically outlined in the contracts between insurers and healthcare providers.
CPT codes are quite similar to but are not exactly the same as the codes from the Healthcare Common Procedure Coding System (HCPCS). Individuals who use Medicare deal with HCPCS codes instead of CPT codes in their paperwork. CPT codes are maintained, developed, and copyrighted by the American Medical Association (AMA). New codes are assigned to new services periodically, current codes are revised, and obsolete ones are thrown out periodically.

Related: Remote Patient Monitoring: What You Need to Know

What role do CPT codes play in Remote Patient Monitoring Reimbursement?

The Centers for Medicare and Medicaid Services (CMS) introduced five primary CPT codes to incentivize more healthcare providers to adopt remote patient monitoring and increase their revenue streams. The five primary CPT codes for the reimbursement of Remote Patient Monitoring include:

CPT 99453
CPT 99454
CPT 99457
CPT 99458
CPT 99091

Amongst these, CPT codes 99453 and 99454 are the Service Codes for RPM.

CPT Code 99453

CPT Code 99453 was designed as a means of assistance for patients who are not tech-savvy, are unable to navigate their mobile phones, or face a difficult time using medical devices. This service code assists them in getting an education on how to use these devices and, in turn, compensates medical health providers in administering these services to the patients.
This includes the time spent for the education or onboarding of patients, as the Centers for Medicare and Medicaid Services (CMS) doesn’t reimburse for the pieces of equipment. The service code covering the enrolment for RPM is reimbursable under this code.

Upon initial setup, CPT Code 99453 can only be billed once. It cannot be billed twice using the same healthcare provider or National Provider Identifier (NPI) number.

CPT Code 99454

CPT Code 99454 is used after the enrolment process of a patient under RPM is complete and monthly services begin. These services are reimbursable under CPT Code 99454, as it is used to alert transmissions and report the administration of healthcare devices for health-related data. CPT Code 99454 is valued for the programming and supply of health-related device(s).

CPT Code 99457

CPT Code 99457 reimburses for the time spent remotely monitoring physiologic parameters such as weight, blood pressure, respiratory flow rate, pulse oximeter, etc., initially 20 minutes per calendar month. It also covers management services and time spent by physicians/ clinical staff/ other qualified healthcare professionals in interactive communication sessions with patients or caregivers during the month. The billing frequency of this code is once every calendar month.

CPT Code 99458

CPT Code 99458 acts as an add-on code to code 99457 that reimburses health care providers for each additional twenty minutes of interactive monitoring sessions each month. This code can be billed up to two times each calendar month.

CPT Code 99091

Although CPT Code 99091 is still valid as per CMS, the codes mentioned before better depict the various medical situations that require billing. It focuses on the data collected in a 30 day period and cannot be billed in the same month as CPT Code 99457 and 99458.

SmartClinix offers an innovative telemedicine platform for easier RMP to boost patient compliance and retention, grow your practice, and significantly add to revenue generation. By becoming a part of the SmartClinix family, you can start your own virtual care program through RPM in only a few easy steps! Head over to SmartClinix to get to know more!