How to Bill for Remote Patient Monitoring

The introduction of remote physiologic monitoring specific CPT® Codes has fueled rapid growth of remote monitoring. However, each of the 5 RPM CPT® Codes have specific requirements for reimbursement and it’s up to your practice (and your RPM software) to ensure you are billing accurately.

First, there are several general requirements for all of the RPM codes, including:

• Patient consent (written or verbal)
• An order from a physician or Qualified Healthcare Professional (specific diagnosis not required)
• Use FDA-defined medical device to collect physiologic data
• Wireless transmission of data

Now, to the specifics for each code:

How to Bill for CPT® Code 99453 for Device Setup

CPT® Code 99453 (average reimbursement $18) covers the initial device setup and patient education. Before billing 99453 the patient must take 16 days of readings within 30 days. It must be readings on 16 individual days, not 16 total readings. 99453 can only be billed once per patient per episode of care, regardless of the number of devices used.

How to Bill for CPT® Code 99454 for Data Transmission

CPT® Code 99454 (average reimbursement $56) covers the transmission of device readings. Specific requirements and restrictions include:

• Patient is required to take 16 days of readings within 30 days - must be readings on 16 individual days, not 16 total readings
• During pandemic, only 2 days of readings required for patients with Covid or suspected Covid (Covid status must be documented)
• Can be billed once every 30 days regardless of the number of devices used

How to Bill for CPT® Code 99457 for Patient Engagement Time

CPT® Code 99457 (average reimbursement $50) covers the first 20 minutes of clinician time spent monitoring the data and engaging with the patient. Specific requirements and restrictions include:

• Monitoring must be conducted by clinical staff, per state laws. Typically nurses and MA’s qualify, but MA’s may be subject to supervision requirements depending on the state
• Monitoring activities include:
  • Reviewing and assessing patient readings
  • Any communication with the patient including text, voice, and video, including patient education
  • Escalating a reading to a physician or other provider
  • Discussing the patient’s data and treatment plan with a provider
  • Charting notes
• Must document a minimum of 20 minutes of time
• At least one live synchronous (audio or video) communication of any length per month must be completed
• Back and forth texts or voicemails count towards 20 minutes, but not to live, two-way communication requirement
• Can be billed even if requirements for 99453 are not met
• Can only be billed once per month (see 99458 if additional time is spent)

How to Bill for CPT® Code 99458 for Additional Patient Engagement Time

CPT® Code 99458 (average reimbursement $41) covers additional 20-minutes of clinician time spent monitoring the data and engaging with the patient. Specific requirements and restrictions include:

• Similar requirements to 99457
• Additional time must be clinically appropriate with documentation
• Does not require an additional live, synchronous call
• Can only be billed after 99457 is billed
• Can bill up to 2 99458’s per month Can be billed even if requirements for 99453 are not met

How to Bill for CPT® Code 99091 for Physician Provided Engagement Time

CPT® Code 99091 (average reimbursement $56) covers engagement time at a higher reimbursement rate but can only be used by physicians and Qualifying healthcare professionals (QHCP). Specific requirements and restrictions include:

• Can only be billed by physicians or QHCP
• Requires 30 minute of clinician time
• Does not require live, synchronous call
• Can be billed without 99453
• Cannot be billed in conjunction with 99457 and 99458, except in specific instances stated in CMS 2021 Rule

Need to Learn More about How to Bill for Remote Patient Monitoring?

More details are available in our complete 2022 RPM Billing Guide (includes CCM, CCCM, and PCM Codes) and our RTM Billing Guide. Or set up a free consultation with one of RPM experts can help answer your questions on RPM CPT® Codes.