CPT® Codes 99453 and 99454: What Healthcare Providers Should Consider
January 3, 2022 •Conrado Tapado
This is the first part of our series on the remote patient monitoring (RPM) CPT® codes. Check out Part 2, which covers CPT® Codes 99457, 99458, and 99091, and Part 3, which addresses some of the most frequently asked questions regarding the remote monitoring CPT® codes.
Remote patient monitoring (RPM) programs have grown in recent years. The COVID-19 pandemic, coupled with advances in technology, and increasing adoption among doctors and patients, have boosted demand even further. In response, the Centers for Medicare and Medicaid Services (CMS) have activated several reimbursement codes for coverage and payment of remote monitoring.
There are five CPT® codes most relevant to providers looking to develop their own remote monitoring programs:
In this post, we’ll break down the first two CPT® codes on that list, 99453 and 99454.
What Do CPT® Codes 99453 and 99454 Entail?
CPT® codes 99453 and 99454 reimburse for expenses associated with providing remote monitoring services used to collect remote physiologic parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate). This includes the cost associated with the monitoring device and distribution of the device to the patient.
99453 is a one-time reimbursement code related to setup. It's meant to take into account the effort spent educating a patient about the device they’re going to be using for monitoring their particular condition.
Note that it can only be used one single time. Regardless of the number of remote monitoring devices a patient uses, or the number of discrete providers caring for the patient, 99453 can be billed only once per episode of care per patient.
99454 is related to the supply of the device (or devices) to be used for monitoring. The device must be ordered by the patient’s physician or other qualified healthcare provider. Additionally, the device must be defined as medical devices by the FDA.
Unlike 99453, 99454 can be used more than once. In fact, 99454 can be reported every 30 days. However, 99454 can be billed by only one practitioner, only once per 30-day period, per patient, regardless of the number of devices used. In other words, even if a patient uses a weight scale, a blood pressure monitor, and a pulse oximeter, 99454 may only be billed once per the 30-day period for said patient.
What to Consider When Billing for 99453 and 99454
Average National Medicare Payment Amount for 99453 and 99454
According to the 2022 Medicare Physician Fee Schedule, the general national payment amount is:
- $18.48 for 99453; and
- $55.77 for 99454
However, commercial reimbursement amounts vary—some are higher, some are lower than others. It’s a good idea to consult with local payer representatives or a local Medicare Administrative Contractor (MAC) to get a more accurate sense of exact reimbursement rates for any given geographic region.
Minimum 16-Day Requirement for Billing
In order to bill for 99453 and 99454, data from an RPM medical device must be transmitted for a minimum of 16 days in a 30-day period. Even if a healthcare provider spends time to educate and distribute an RPM device to a patient, 99453 should not be reported if monitoring is less than 16 days.
Thus, it’s imperative that patients are actively engaged in taking their measurements, so the data can be transmitted on at least 16 days within the 30-day reporting period. Additionally, the medical device data must be electronically (i.e., automatically) collected and transmitted and not self-reported by the patient.
COVID-19 Exception to 16-Day Rule
For patients with suspected or confirmed cases of COVID-19, there is an exception to requiring 16-days of data. For the duration of the COVID-19 public health emergency (PHE), at least 2 (two) days of monitoring are required for those patients with suspected or confirmed cases of COVID-19 in order to bill 99453 or 99454. Again, this only applies to patients with suspected or confirmed cases of COVID-19.
Our Recommended Best Practices for Utilizing 99453 and 99454
Meet in Person for Initial Setup
The pandemic has changed the way many businesses operate. Healthcare providers are now conducting many appointments through remote sessions. It can be an adequate option for some situations, but certainly not for all.
For the initial setup, it’s ideal to meet with patients face-to-face. By doing so, you can demonstrate the device, and then observe the patient set up and use it. This hands-on coaching can be especially beneficial for patients who may be less experienced with technological devices. In the long-term, this actually saves time. Trying to get a patient setup remotely will likely take longer. Also, getting off on a solid start will positively impact sustained patient engagement and retention For the initial setup, it’s ideal to meet with patients face-to-face. By doing so, you can demonstrate the device, and then observe the patient as they set it up and use it for the first time. This hands-on coaching can be especially beneficial for patients who may be less experienced with technological devices. In the long-term, this actually saves time. Trying to get a patient setup remotely may likely take longer. Also, getting off on a solid start can positively impact sustained patient engagement and retention.
Note, that this in-person setup is generally going to be required by CMS, but has been temporarily waived for the duration of the PHE. When the PHE ends, in-person setup must resume.
Employ Easy-to-Use Technology
No matter how impressive your patient education materials may be, having equipment that is simple for patients to use is essential. Devices that employ cellular communications technology, versus Bluetooth, can ensure more reliable data collection and transmission. If patients find the equipment cumbersome, there’s going to be a higher risk of non-compliance.
Train the Trainer
There are a number of devices on the market that can serve the needs of various RPM programs. For the purposes of 99453, they all serve the same purpose – generating and wirelessly transmitting patient physiological data. However, each of these devices may have different functionality.
When choosing an RPM solution, it’s important to find technology vendors that provide support and training. A dedicated support manager can demonstrate and teach the intricacies and nuances of the device to the dedicated clinical staff at your office who will ultimately distribute them to patients.
Engage with Patients to Ensure Compliance
RPM systems with automated reminders can help with compliance. A smart reminder enables providers to set up a schedule for patients. If the patient misses the recording, the patient will get an automated text or phone call. The result will be more readings with less effort. With the right equipment, training, and systems in place, healthcare providers can handily leverage technology to offer RPM services and report 99453 and 99454.
Choosing the right RPM program might seem like a daunting task. It can be tempting to simply choose the least expensive option. However, it’s wise to take time to research which ones will work best for you and your patients. The level and quality of customer service, and seamless technology can have a big impact on your RPM experience. If you’d like to learn more, you can request a demo to see how Optimize Health can work for you.
The Optimize Health 3-Part Remote Patient Monitoring CPT® Code Series
Part 1 (current): CPT® Codes 99453 and 99454: What Healthcare Providers Should Consider
Part 2: CPT® Codes 99457, 99458, and 99091: What Healthcare Providers Should Consider
Part 3: Remote Monitoring CPT® Codes Frequently Asked Questions
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