CMS Billing

CMS Remote Patient Monitoring Coding

cms remote patient monitoring billing and codingAs physicians, you and your staff are spending an ever-increasing amount of time utilizing the latest technology to enhance and improve patient care – especially regarding chronic illnesses.  As such, you are finally being recognized for these services as the CMS has published a new set of Chronic Care Remote Physiologic Monitoring (CCRPM) codes.

Here’s what the AMA had to say about the latest additions to the CPT that reflect the coding demands of today’s modern health care technologies & systems:

“The AMA has urged the Centers for Medicare & Medicaid Services to adopt the new codes for remote patient monitoring and internet consulting and designate the related services for payment under federal health programs in 2019,” said AMA President Barbara L. McAneny, MD.  “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care.”

The 2019 Medicare Physician Fee Schedule created 5 new codes in the category of CCRPM for the following:

  1. Initial set-up & patient education
  2. Initial device supply
  3. Monitoring data & interacting with patients/caregivers

What are the new Chronic Care Remote Patient Monitoring Codes?

Below are the final code descriptors for the new CCRPM codes:

  • CPT Code 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 – rate set at $19.
  • CPT Code 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, every 30 days – rate set at $55.
  • CPT Code 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 – rate set at $41.
  • CPT Code 99458: Additional 20 minutes of Remote physiologic monitoring treatment management services, by clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month – rate set at $41.
  • CPT Code 99091: The collection & interpretation of patient data by Physician or QHCP; minimum of 30 minutes – rate set at $56.

CMS Billing FAQs

At least 20 minutes per calendar month is required (which differs from the 30 minutes per 30 day period for CPT 99091). CPT 99457 is much easier to track because it is based on a calendar month, which should more easily align with recordkeeping and claims submission.
RPM services can be performed by the physician, qualified healthcare professional, or clinical staff.
There are 3 main differences: 1) CPT Code 99457 requires 20 minutes of time spent while CPT 99091 requires 30 minutes. 2) Time for CPT Code 99457 is based on calendar month, not the 30 days period in CPT code 99091. 3) Allows for time spent by clinical staff, while CPT Code 99091 was limited to time spent by Physicians & Qualified Health Care Professionals.
Yes! This is what CPT Code 99453 (initial setup & education) and CPT Code 99454 (supplying the device) are for.
No, the patient can be located anywhere in the U.S. Medicare pays for RPM services under the same conditions as in-person physicians' services with no additional requirements regarding permissible originating sites or rural geographies.
Yes, as a Medicare Part B service, the patient is responsible for a 20% co-payment for RPM services.
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