CMS REIMBURSEMENT 

With Remote Patient Monitoring (RPM), providers can leverage physiological data to improve chronic disease management. Covered by Medicare Part B, it's imperative for providers to familiarize themselves with the CPT billing codes applicable to RPM to optimize care delivery and prevent claim denials.

 

RPM is a covered service for Medicare Part B patients with a nominal co-pay. This monthly program offers patients personalized care plans, ongoing engagement from the care team, and informed management of their conditions.Under Medicare's Physician Fee Schedule, RPM is reimbursable at various rates. Here are some essential details regarding RPM * CPT Codes: 99457, 99453, 99454, and others. These remote monitoring CPT codes correspond to specific activities, such as device setup or care provision, each with its own reimbursement rates and restrictions. For instance, providers typically receive $48.14 for 20 minutes of service per patient per month (99457).

 

Additional opportunities for higher billing thresholds exist, such as an additional $46.50 per month when patients utilize their RPM device daily (99454).Regarding best practices:-

 

* CPT code 99453 (device setup) can only be claimed once per device, per patient, per month.-

 

* CPT code 99454 (device use) can be claimed once per patient per month, regardless of the number of devices used. It should be billed in 30-day increments if the patient takes at least 16 daily device readings within that month.

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It's crucial to align claims submissions for these codes since code 99454 can be billed every 30 days, while codes 99457 and 99458 (program time) are billed on a monthly basis. We recommend submitting all RPM-related claims together by calendar month.

 

About RPM and its billing requirements: RPM is a telehealth program for Medicare Part B beneficiaries. Patients use digital devices to self-collect physiological data, which is then transmitted to their provider for review and management of chronic conditions.

 

RPM has proven effective, particularly for managing conditions like hypertension, and payors are increasingly investing in similar programs to promote value-based care models.

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Patients covered by Medicare Part B receive 80% coverage for RPM, with many secondary insurances covering the remaining cost.

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RPM services are billed monthly, from the first to the last day of each month.

 

Starting in 2024, meeting FDA criteria for designated medical devices is a requirement from CMS for RPM devices. This encompasses various tools such as weight scales, blood pressure monitors, pulse oximeters, glucometers, heart rate monitors, thermometers, and spirometers. We're excited to share that our FDA-approved devices are now accessible.