Thanks to the clarification of several relevant CPT codes, billing for remote patient monitoring (RPM) services has never been easier. The Centers for Medicare and Medicaid Services (CMS) released statements clarifying some of the wording on five RPM-related CPT codes on August 3, 2020. Further clarifications were issued on January 19th, 2021.
These newly clarified codes have significant repercussions for the future of remote monitoring services in medical settings. This guide will outline what you need to know about reimbursement for remote patient monitoring in 2021, including the implications of these new changes.
Remote patient monitoring is covered by Medicare. As of July 2020, it's also covered by 23 state Medicaid programs.
What can you expect to get paid for providing remote patient monitoring services? In 2020, the CPT codes assigned to RPM made RPM one of the better reimbursing Medicare care management programs.
The final versions of the five remote patient monitoring reimbursement codes that were affected by these statements are as follows:
CPT Code 99453 covers one-time reimbursement for the time spent setting up a remote monitoring device and teaching the patient how to use it, as well as any additional services needed to enroll the patient on-site. Providers may bill for this code once every 30 days and once per episode of care, but they must record at least 16 days of readings within that 30-day billing period.
CPT Code 99454 may be billed monthly and reimburses healthcare providers for the cost of leasing a connected home health care device for a patient, as well as the cost of the software needed to run it (usually delivered under a SAAS model). At least 16 days of reading must be recorded in each billable 30-day period.
The device must be a leased item that was ordered by the patient’s physician or qualified healthcare professional (QHP) and must not have been previously owned by the patient. It must also be intended for home use and must automatically upload the patient’s health data to their care provider each day.
Code 99457 reimburses physicians and QHPs for the time spent remotely monitoring a patient’s health data as part of their treatment management services. Providers may bill for this code on a monthly basis but must spend at least 20 minutes each month providing remote patient monitoring (RPM) services to the patient. Recent clarifications specify that this time is not limited to ‘interactive communication’ with patients; providing care management services from a distance qualifies as well.
CPT Code 99458 is a corollary code to Code 99457 and allows providers to bill for each additional 20-minute block of time they spend providing RPM services for a patient each month.
CPT Code 99091 reimburses physicians and QHPs for the time they spend collecting and interpreting physiologic data that was digitally stored or automatically transmitted by the patient or their caregivers. This code may be billed once every 30 days and requires at least 30 minutes of time to be spent on these tasks within that 30-day period.
Connected medical devices hold immense potential for improving patient health outcomes, but they are relatively new technologies. Until recently, there were few established insurance billing practices to support their use in real-world settings. This limited healthcare providers’ ability to implement connected patient monitoring without offloading the costs onto their patients.
The recent clarifications to these five patient reimbursement codes allow healthcare providers to fully embrace the power of connected health devices without worrying about how they will bill for the time they spend using them to manage their patients. Every step of the implementation process from set-up to analysis and monitoring now has an associated billing code and can be easily logged, reported, and paid for, even if it is conducted remotely.
The explicit acceptance of remote care management in the clarified codes makes remote data collection a far superior choice to local data collection from an efficiency standpoint. The choice to implement billing for codes 99457, 99458, and 99091 in 20-minute blocks also incentivizes the use of devices that incorporate AI and machine learning into their software. When these reimbursements are added together, the amount a single remote monitoring patient can earn a practice is up to $210 per month. A practice will typically furnish about 20 minutes of RPM care management per month to a patient, which will bring the total monthly reimbursement to around $120 per Medicare beneficiary.
These tools can take over much of the routine work involved with remote patient monitoring, leaving those 20 minutes for direct communication with patients and other complex, high-value work. As a result, AI-enabled remote patient monitoring devices are expected to become the preferred choice of buyers in the US market.
Remote patient monitoring platforms are an integral part of RPM infrastructure, and choosing the right one could significantly streamline the amount of work involved with insurance billing and patient reimbursement. BioT includes useful tools to help healthcare providers easily manage the financial aspects of their practice.
Our software's Reimbursement module is designed specifically to address the needs of busy healthcare providers seeking to manage RPM billing across a large number of patients. This module tracks the total amount of time spent delivering care to each patient with at least one remote monitoring device connected to the platform during a given month. It then creates automatic reports for all patients who have met the criteria for one or more of the RPM reimbursement billing codes that month. With this information on hand, reimbursement is made swift and simple.
Our platform can also help you to maximize the financial compensation you receive for remote patient monitoring services. The software can be configured to send out alerts for caregivers who are just a few minutes shy of the threshold for billing eligibility for a particular patient that month. Those caregivers can then provide that patient with a few more minutes’ worth of services to make sure that their time is properly remunerated.
Now that remote patient monitoring has become clearly recognized in CPT coding, this type of care is poised to become much more widespread in the coming years. BioT makes it easy to deliver top-tier remote care and to be reimbursed by insurance companies for doing so. Contact us today for more information on our medical IoT platform and how it can help you bring the benefits of remote monitoring to your patients.