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Remote monitoring codes: appropriate usage and revenue calculator

Remote Patient Monitoring (RPM) has been recognized by CMS as an integral part of the future of healthcare. CMS has identified that the quality of patient care can improve with the implementation of these new technologies, and therefore re-evaluated their CPT codes for providing these types of services. We explore the appropriate usage of RPM and revenue calculator.

Medicare introduced new codes for RPM in January 2019. The codes were designed to accurately reflect the steps in implementing and utilizing RPM as a patient care tool in the current healthcare environment. Monitoring examples include but are not limited to weight, blood pressure, pulse oximetry, respiratory flow rate.

The new Chronic Care Remote Physiologic Monitoring codes are:

CPT code 99453: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
– Reimbursement – $23.79
– Billed one time at set-up
– The patient must have been seen by the practitioner within one year prior to initiating RPM services
– Service cannot be billed if less than 16 days

Expert tip: This code reimburses care providers for time spent by setting up the patient’s monitoring device and educating them on its use.

CPT code 99454: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
– Reimbursement – $77.64
– Billed from the start date of the monitoring
– Service cannot be billed if less than 16 days

Expert tip: This code doesn’t require a minimum time spent but rather requires a service that allows a provider real time access to patient’s data recorded with a monitoring device or such service includes notification of recorded events. This code reimbursement requirement could be satisfied by monthly reviews of recorded patient data.

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.”
– Reimbursement – $59.86
– Billed per calendar month

Expert tip: This code is complementary to code 99454 and can be billed together when a provider engages in patient/caregiver interactive communication such as phone call, video call or other non-face-to-face communication related to RPM services such as discussing the patient’s data, medication, and change in treatment plan, etc.

Documentation and Usage

As with all new CPT codes introduced by CMS, there are questions with their proper and compliant usage.

– Prior to billing the RPM codes, the patient must provide verbal consent which needs to be clearly documented in the medical record.
– The standard 20% Medicare deductible and co-insurance applies for all RPM codes.
– There are no formal polices currently available from CMS for appropriate documentation for these services.
– As a best practice, when a Provider identifies a patient who can benefit from the utilization of RPM technology, it must be clearly documented in the medical record.

– Documentation should be based upon the provider’s clinical judgment of the patient’s condition and include:
– Nature and severity of condition
– Detailed history of condition
– Medical necessity and clear rationale for monitoring
– Goals to be achieved by RPM

Provider Types who can bill CPT 99457

– CPT Code 99457 allows RMS services to be performed by physicians, qualified healthcare professionals or licensed clinical staff operating within their scope of state law, including medical clinical assistants.
– Incident-to services are permitted, under “direct supervision”.
– Direct supervision requires that the physician and auxiliary personnel must be in the same building at the same time (albeit not the same room).

The Relationship between Chronic /Complex Care Management Services and Remote Patient Monitoring

Physicians may report CPT Codes 99490-99491 (Chronic Care Management Services) and CPT Codes 99487-99489 (Complex Chronic Care Management Services) with the RPM codes if these services are being provided simultaneously.

The CCM Codes have a distinct set of guidelines, which differ from RPM. It is important for Physicians to understand that the individual guidelines for both code sets must be documented in the patient medical record, and time spent providing these services cannot be counted towards the required time for both CCM and RPM in a single month. For example, if a patient is receiving CCM services which require 20 minutes of documented time per month, as well as RPM monitoring which require another 20 minutes, these times cannot overlap. A minimum of 40 minutes total must be documented in the medical record for both services.

*CPT Code 99091 cannot be reported with RPM. The new RPM codes provided by CMS more accurately reflect the services being performed.

This guest post has been provided by Nancy Rowe, CPC, CPMA, CRC of Practice Provider Corp., New York

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