In the evolving landscape of healthcare, Remote Patient Monitoring (RPM) has emerged as a critical component of telehealth, offering a bridge between traditional in-person visits and the need for continuous remote patient care. The adaptation to RPM has been accelerated by the digital transformation spurred by the COVID-19 pandemic, highlighting the necessity for sleep medicine providers to navigate the complexities of billing and coding to secure appropriate reimbursement.
This guide aims to demystify the billing process of RPM, focusing on the essential CPT codes that practices need to understand and utilize effectively. By leveraging RPM, sleep medicine providers can offer more personalized, timely care while ensuring financial sustainability in a post-pandemic world where telehealth is not just an option, but a staple of patient-centered care.
Remote Physiologic Monitoring CPT codes | |
CPT 99453: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. | $19.65 |
CPT 99454: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. | $46.50 |
CPT 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. | $48.13 |
CPT 99458: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes. | $38.64 |
Medicare national payment amounts - reimbursement will vary.
CPT 99453: Setup
CPT 99453 covers the initial setup and patient education on using RPM devices, such as a pulse oximeter or home sleep test device.
Medicare national payment amount: $19.65
This code can only be billed once per episode of initiating remote patient monitoring for a patient
CPT 99454: Monitoring
CPT code 99454 is a cornerstone in the billing and coding framework for Remote Patient Monitoring. This code covers the monthly reimbursement for the supply of RPM devices and the monitoring of physiologic data.
Medicare national payment amount: $46.50
To bill, monitoring must occur over at least 16 days of a 30-day period
This code can be billed once every 30 days
Monitoring services are restricted to one claim per patient per 30-day period, regardless of the number of devices provided.
CPT 99457: Care management
This code is designed to compensate healthcare providers for their time spent managing and coordinating patient care through RPM technology. Specifically, it covers the initial 20 minutes of time spent on care management by clinical staff, the physician, and/or other qualified healthcare professionals. It must include interactive communication with the patient or their caregiver.
Medicare national payment amount: $48.13.
To bill, clinical staff must spend 20 minutes on care management.
This code can be billed once every calendar month.
Care management services can be performed by the billing provider or clinical staff under the general supervision of the billing provider.
This code can be billed even if the requirements of CPT 99454 are unmet.
CPT 99458: Care management add-on
This code serves as an extension to CPT 99457. It covers additional 20-minute increments of time spent by clinical staff, physician, or other qualified healthcare professionals on care management, beyond the initial 20 minutes covered by CPT 99457.
Medicare national payment amount: $38.64.
To bill, clinical staff must spend an additional 20 minutes on care management.
Care management services can be performed by the billing provider or clinical staff under the general supervision of the billing provider.
This code can only be billed in combination with CPT 99457.
Implementing Remote Patient Monitoring
Implementing Remote Patient Monitoring billing within your practice requires adherence to specific guidelines to ensure compliance and reimbursement. Key points for effective RPM billing include:
Eligibility for providing RPM services: Only physicians and non-physician practitioners, such as nurse practitioners and physician assistants who can bill Medicare for Evaluation and Management (E/M) services, are authorized to order and bill for RPM services using CPT codes 99453, 99454, 99457, and 99458. These services are designed for both acute and chronic conditions but are distinct from diagnostic tests, hence cannot be billed by Independent Diagnostic Testing Facilities.
Specific billing requirements: When a more specific CPT code exists for a particular remote monitoring service (e.g., continuous glucose monitoring or self-measured blood pressure monitoring), that specific code should take precedence over general RPM codes.
Compliance with CMS guidelines: Providers billing CMS for remote patient monitoring services must ensure:
A 20% copayment is charged to Medicare Part B patients.
Patients provide consent to RPM services, either in writing or verbally.
The service is ordered by a qualified healthcare professional.
RPM devices comply with the FDA's definition of a medical device, ensuring the safety and efficacy of the technology used.
Adhering to these principles aligns your practice with regulatory expectations and maximizes the potential for reimbursement, ensuring patients receive high-quality, continuous care for their sleep health needs through RPM services.
The information in this document is being provided on an “as is” basis with no express or implied warranty of any kind and should be used for your internal informational purposes only. The information provided in this document does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. Before filing any claims, it is your sole responsibility to verify current requirements and coverage policies with the applicable payer.
Current Procedural Terminology (CPT®️) codes, descriptions and other data only are copyright 2024 American Medical Association (AMA). All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components aren’t assigned by the AMA, aren’t part of CPT, and the AMA isn’t recommending their use. The AMA doesn’t directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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