Which CPT Codes are Used in Remote Patient Monitoring Billing?

There are three main codes that come into play with RPM:

1. 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment
2. 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
3. 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

Let’s break those down a bit further:

99453 – Initial Set-Up and Education

This code covers the initial work involved in getting a patient set up for RPM services.

It includes:

• Providing the patient with the necessary devices for monitoring their vital signs/health data
• Educating the patient on how to properly use the devices and transmit their data
• Any other work required to get the RPM process up and running for that patient

You can only bill this code once per episode of care – not every 30 days like some of the other codes.

99454 – Device Supply and Monitoring

This code is for the actual supply of the RPM devices and the daily monitoring that happens each 30-day period.

So every 30 days, you’d bill this code to cover:

• The devices themselves (e.g. blood pressure cuff, weight scale, etc.)
• The transmission of the patient’s daily monitoring data
• Any automated alerts or messaging based on that data

You can bill this code every 30 days as long as the patient remains on RPM services.

99457 – Treatment Management

This code covers the clinical staff/provider time spent reviewing and addressing the RPM data that comes in each month.

Specifically, it requires at least 20 minutes of interactive time with the patient/caregiver spent on things like:

• Monitoring the RPM data for any concerning readings
• Following up with the patient about those readings
• Adjusting the patient’s treatment plan based on the RPM data
• Providing additional education or recommendations

This code can only be billed once per calendar month, regardless of how much time is actually spent on treatment management.

Those are the three main CPT codes for RPM billing.

Yet, there are a couple of other codes that may come into play in certain situations:

99091 – Data Collection and Interpretation

This code covers the collection and interpretation of remote physiologic monitoring data that is not covered under the 99453, 99454, and 99457 codes.

It might be used for things like:

• Reviewing RPM data from a 30-day period after the 99457 code has already been billed for that month
• Analyzing RPM data from multiple non-continuous 30-day periods
• Collecting and interpreting additional RPM data beyond the standard services covered by the other codes

99473 and 99474 – Remote Therapeutic Monitoring

These codes are specifically for remote therapeutic monitoring services, which involve monitoring a patient’s adherence to their prescribed therapy (e.g. confirming they took their medication, doing their prescribed physical therapy exercises, etc.).

99473 covers the initial setup and patient education for these services, similar to 99453. 99474 covers the actual device supply and monitoring each calendar month, similar to 99454.

While these codes don’t directly relate to monitoring physiologic parameters like the other RPM codes, they could potentially be used in conjunction with them for certain patients.

Beyond just knowing the CPT codes, there are a few other important things to understand when it comes to billing for remote patient monitoring:

Requirements for Billing RPM Codes

To bill for RPM services using the codes above, you have to meet some specific Medicare requirements, including:

• Having an established provider-patient relationship
• Providing RPM services under a physician’s order/supervision
• Using approved medical devices that meet the FDA’s definition of a “medical device”
• Ensuring the RPM data is automatically transmitted to you (not self-entered by the patient)
• Having an established data management system in place

If you can’t meet all of those requirements, you wouldn’t be able to bill using the RPM codes. So be sure you understand and comply with them.

Cost-Sharing for Patients

For Medicare patients, the cost-sharing for RPM services works the same as it does for standard office visits:

• 99453 has no cost-sharing for the patient
• 99454 is subject to the standard Medicare Part B deductible and 20% co-insurance
• 99457 is subject to the standard Medicare Part B deductible and 20% co-insurance

Insurance coverage for RPM services can vary for non-Medicare patients, so you’ll need to check with each payer on their specific cost-sharing policies.

Use of Clinical Staff vs. Physician Time

While the 99457 code does allow for clinical staff time to be counted, it’s worth noting that physician/qualified healthcare professional time is valued higher than clinical staff time.

The Medicare reimbursement rates reflect this, with more money being paid out when more of the 20+ minutes for 99457 is spent with a physician versus clinical staff.

Private Payers & RPM Coverage

It’s also important to be aware that while Medicare has embraced RPM billing, coverage can vary significantly among private payers.

Some private insurers have been slow to cover RPM services or only cover them in limited circumstances. Others have adopted coverage policies similar to Medicare’s.

So you’ll want to check each payer’s guidelines carefully and get any required pre-authorizations before providing RPM services to patients with private insurance.

Billing RPM with Other Services

Finally, keep in mind that RPM services can potentially be billed alongside other services like:

• Chronic care management (CCM)
• Transitional care management (TCM)
• Behavioral health integration (BHI)
• Principal care management (PCM)

However, there are rules about “double-dipping” that prevent you from billing the same time/work to multiple service codes. So you’ll need to carefully track your time to ensure you’re not double-billing for any RPM-related work.

To wrap things up, here are the key takeaways when it comes to CPT coding and billing for remote patient monitoring services:

• The three main CPT codes are 99453 (initial setup), 99454 (device supply/30-day monitoring), and 99457 (treatment management)
• You also may use codes like 99091 (additional data review), 99473 / 99474 (remote therapeutic monitoring) in certain situations
• Make sure you meet all of Medicare’s RPM billing requirements, like using approved medical devices and having the data automatically transmitted
• Be aware of patient cost-sharing responsibilities, which differ across the RPM codes
• Carefully track clinical staff vs. physician time, as physician time is reimbursed at a higher rate
• Check each private payer’s RPM coverage policies, as they can vary significantly
• You may be able to bill RPM services alongside other care management codes, but watch out for double-billing issues
• Stay on top of any future changes to RPM coding/billing, as this area of healthcare continues evolving rapidly