Medicare has been offering reimbursement for the “collection and interpretation of physiologic data the beginning of 2018, it recently published 3 specific CPT codes: CPT code 99453, CPT code 99454 and CPT code 99457, which were created to monitor and manage patient care needs and to better support current RPM services.
First, the patient must opt-in for the service. Devices used must meet the definition of medical device, as defined by the FDA. The service must be ordered by a physician or other qualified healthcare professional, monitoring must be greater than 16 days to be applied to a billing period and the data-monitoring services may be performed by the physician, by a qualified healthcare professional, or by clinical staff. Clinical staff may include, for example, RNs and medical assistants (subject to state law). Data must be wirelessly synced where it can be evaluated.
There are 5 new CPT codes to bill:
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.
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.
Assuming the physician provides this service to just 20% of their Medicare-covered patients, they could end up generating over $400,000 of additional revenue per year.
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Yes. The old telehealth CPT Code 99091 is limited only to “physicians and qualified health care professionals” and does not expressly allow the RPM service to be delivered by clinical staff (e.g., RNs, medical assistants, etc.). This means the physician or qualified health care professional must personally perform (and document) the full 30 minutes per 30-day period, which is a lot of time for these highly trained professionals. For some providers, this is too resource-intensive to justify the $58.68 per month reimbursement rate. However, this new CPT codes allows RPM services to be performed by clinical staff.
No. This is not a 24/7/365 monitoring service. This service is different than telehealth as you can bill for setup & education and equipment now. In addition, you only have to spend 20 minutes per calendar month (as opposed to 30 minutes per 30 day period) and you can have your clinical staff monitor.