Remote monitoring CPT codes: CMS finalizes changes for 2021

Remote monitoring CPT codes: CMS finalizes changes for 2021

The Centers for Medicare and Medicaid Services (CMS) has established reimbursement rates for remote physiologic monitoring (RPM) services since 2018 using Current Procedural Technology (CPT) codes. The relevant remote monitoring codes are 99453, 99454, 99457 and 99458, with new clarifications and changes added each year. So what does 2021 mean for remote patient monitoring?


Patients with acute conditions now qualify for reimbursement
CMS clarified in 2019 that physicians can use RPM services to collect data and analyze patients if they have a chronic condition. However, CMS have now finalized in the 2021 changes that patients with acute conditions are also included. This new addition allows for a wider scope and range of RPM applications for patients.


Medical devices must meet the FDA’s definition to qualify
CMS has specified that in order to bill for CPT code 99454 specifically, the device supplied to the patient must be a medical device as described in section 201(h) of the Federal Food, Drug, and Cosmetic Act (FFDCA) and must be “valid and reliable” with data that is electronically collected and transmitted. Qardio’s smart blood pressure monitor, QardioArm, is one of the accepted medical devices.


Physicians and patients must have an interactive communication
In regard to billing specifically for CPT codes 99457 and 99458, CMS has defined an “interactive communication” as a two-way audio conversation such as a phone call, that can be enhanced with video. The 20 minutes required to bill 99457 and 99458 can include interactive communication as well as furnishing care management services.


Auxiliary personnel under supervision can also furnish certain CPT codes
Currently, remote monitoring codes CPT 99453 and 99454 can only be furnished by physicians, qualified healthcare professionals and clinical staff under the general supervision of the physician. However, CMS have established in the 2021 changes that auxiliary personnel will also be able to furnish these CPT codes under supervision. This includes employees or leased or contracted employees.


Patients must have an established relationship with physicians
CMS has explained that an “established patient-physician relationship” is needed for RPM services to be furnished. During the COVID-19 pandemic, this was waived, to allow for physicians to rapidly set up treatments and care plans remotely without having to gather patients’ medical history or conduct a physical exam. However, it has been finalized that from 2021, an “established relationship” will be required once more.


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American Medical Association