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CPT® Codes For RPM Explained to Help for Your Practice – Part Two

CPT® Billing 99091: Encouraging the Use of Remote Patient Monitoring 

Shortly before the world shut down because of COVID-19, the Centers for Medicaid and Medicare Services pushed to encourage all practices to utilize Remote Patient Monitoring.

Though RPM had limited use before then,  it had shown a significant reduction in hospitalization. By using connected devices such as scales, blood pressure cuffs, and glucose meters, healthcare providers had more information and could develop better treatment plans for more positive outcomes. Furthermore, the patients truly enjoy the service.

For chronic conditions, like diabetes, hypertension, or COPD, having daily measurements sent to care teams provided invaluable information to keep patients healthy.

Then in 2019, the CPT® added three new billing codes to encourage Remote Patient Monitoring.

They are:

  • CPT® code 99453: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up, and patient education on the use of equipment.” 
  • CPT® code 99454: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, every 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.”

The American Medical Association also added the following requirements:

  • Advance patient consent: practitioners must obtain advanced consent for the service and document the consent in the patient’s record. 
  • 30-day reporting period: billing is limited to once in 30 days. (This would be further amended to be a calendar month, which is easier for billing, rather than any 30 days).
  • Use with other services: billing is permitted for the same service period as chronic care management (CCM) (CPT® codes 99487-99490), transitional care management (TCM) (CPT® codes 99495-99496), and behavioral health integration (BHI) (CPT® codes 99484, 99492-99494). 
  • The Medicare program will be issuing additional guidance on the type of Remote Patient Monitoring technology that will be permitted under 99454. 
  • CPT® codes 99457 and 99091 may not be billed together for the same billing period, and beneficiary

We’ll go into further details about each code in later posts.

Medek RPM can make sure any practice meets all the requirements of all CPT® codes. We have a team of professionals who stay on top of all the changes and work with a practice’s financial team to create the best financial return for their investment.

Medek RPM’s team of care professionals works with patients directly, keeping the providers up-to-date on patients’ health status and ensuring the best care.

To learn how Medek RPM can assist your practice and your patients, please reach out to us directly.

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