Many Medicare billing guides focus on reimbursement requirements but often lack clear steps on how to successfully and accurately bill Medicare for RPM services.
Billing processes, steps, and tools can support seamless and successful reimbursement or cause frustration, denied claims, and double work.
As a Medicare program to monitor patient vitals at home, Remote Patient Monitoring (RPM) collects data that providers can use to manage chronic and acute conditions, foster patient engagement, and prevent disease progression or hospitalizations.
The following guidance provides necessary steps and helpful information to make Medicare billing easier and more compliant. This can help improve reimbursement and reduce the risk of claim denials.
There are four essential steps to bill for RPM services. These steps include:
These steps can be carried out manually, or providers can use care management software. This can help automate efficient and compliant RPM management, streamlining the process of submitting claims to Medicare.
At the time of monthly billing, providers and staff have already met patient eligibility and consent requirements to enroll and onboard the patient.
As part of step one in preparing a monthly bill to Medicare for RPM services is ensuring that the claim includes five items required by Medicare, including:
Each of these required items has rules or best practices associated with them.
Current Procedural Technology (CPT) codes are numbers assigned to every task and service a medical practitioner may provide to a patient, including medical, surgical, and diagnostic services.
Insurers use these codes to determine and verify the financial reimbursement a practitioner will receive for that service.
A CPT code is a five-digit numeric code with no decimal marks (although some have four numbers and one letter).
Remote Patient Monitoring has four CPT codes that allow providers to reimburse for initial device setup, monthly device use and readings, and time used for non-face-to-face care coordination, communication, and RPM data review.
*The reimbursement rates listed are from the 2025 Physician Fee Schedule. They are based on a national average and may vary by location. See the 2025 Medicare Physician Fee Schedule Final Rule for up-to-date rates.
ICD-10 codes identify which medical diagnoses are associated with the care a provider delivers and why. ICD-10 codes work in tandem with CPT codes and are required on every claim submission.
Billing for RPM requires at least one ICD-10 code and many chronic and acute conditions qualify for RPM reimbursement.
These medical conditions can include acute conditions or post-surgical recovery, as well as chronic conditions such as hypertension, diabetes, congestive heart failure, obesity, COPD, asthma, heart disease, Parkinson's disease, and low back pain.
According to Definitive Healthcare, the following are among the most common ICD-10 codes billed for RPM services:
When billing for Remote Patient Monitoring (RPM), providers must report at least one ICD-10 code to link the diagnosis to the RPM service being delivered.
While choosing the date of service seems straightforward, it can be complicated with time-related programs like RPM.
A valid Date of Service must meet the following criteria:
To ensure accurate and compliant service dates, ThoroughCare defaults time related claims to the date of the last time log for the patient in the given month.
This is because RPM claims are created when the patient reaches 20 minutes (CPT code 99454) for the month. While this would be considered the billable date, when additional 20-minute increments are billed (CPT code 99458), the date of service is the date of the time log that puts the patient at the next tier.
We recommend that providers hold off billing until the end of the month to ensure that all time-based codes are documented since only one bill can be submitted each month for RPM.
Medicare allows only one practitioner to bill for RPM services for a patient in a 30-day period, regardless of the number of devices the patient may use in a given month.
Insurances Medicare may deny RPM claims for numerous reasons, including:
Most importantly, the clinical team should maintain detailed records that could stand up to audit and provide rigorous proof when responding to a claim denial.
The following RPM activities should be easily captured, accurate, and reportable as part of billing and compliance:
While payers Medicare do not doesn’t ask providers to use specific software, they require that any RPM device can digitally upload patient data, which must be accurate and accessible.
However, RPM and care management software enable providers to not only manage and bill for RPM services but also maximize the value of patient data through automated alerts, analytics, and reports.
Supported by robust and flexible software, clinicians and their billing staff can:
Our software platform was built to help providers meets Medicare requirements for care management programs like Remote Patient Monitoring. Through flexible and filterable patient worklists, dashboards, automated code capture, data analytics, alerts, and reports, clinicians can deliver RPM services efficiently and submit accurate claims.
Here are just a few features that make ThoroughCare a robust complement to the electronic medical record when managing and billing for RPM services:
Automatically assign CPT codes: Depending on the type of treatment and the amount of time logged, ThoroughCare automatically assigns the proper CPT code. This automated billing code assignment also provides an audit trail. And, new in 2024, ThoroughCare automatically enables CPT code 99457 when a practice activates the interactive communication requirement and completes documentation for the RPM call.
Searchable ICD-10 code lists: ThoroughCare provides an easily searchable list of appropriate ICD-10 codes for chronic and acute conditions available for RPM. Each year, our team ensures that the ICD-10 code workflow has been updated to deal with any deprecated codes.
Automated time tracking and documentation: ThoroughCare includes a task tracker with timer and time-logging capabilities. The software automatically assigns the proper corresponding CPT code if and when the patient becomes billable for RPM.
Customizable data alerts and analytics: Clinicians and care managers can set custom parameter notifications for each patient. There are three types of parameters: normal, caution, and critical level. If a patient’s RPM readings are outside those parameters, the patient, staff, and clinicians can choose how they want to be alerted via push notifications, email, or text.
All data readings are visualized on various dashboards or in reports. Additionally, providers can drill down instantly into all readings and filter to highlight certain types of measures or timeframes.
Data integration with devices, EHRs, and HIEs: With more than 400 RPM devices available for order, drop-ship, or integration with ThoroughCare, clinicians can easily secure the most appropriate device and quickly onboard patients. Data integration with devices is also complemented by seamless data exchange with EHRs and Health Information Exchanges.
In addition to these critical features, ThoroughCare offers an end-to-end workflow for Remote Patient Monitoring with comprehensive care planning tools and evidence-based assessments. Other care management programs, such as Principal Care Management, Transitional Care Management, and Behavioral Health Integration, are instantly available by enrolling RPM patients.
In addition to meeting CMS requirements for patient enrollment and consent, providers must include five items when billing Medicare for RPM services:
Billing staff should also perform four essential steps when billing Medicare and patients for RPM services, including:
The most frequent reasons Medicare may deny RPM claims include:
Maintaining detailed documents, actions, time, and activity logs improves billing accuracy and provides an audit trail for replying to Medicare denials.