With Remote Patient Monitoring (RPM), providers can use physiological data to enhance chronic disease management. Covered by Medicare Part B, providers should learn what CPT billing codes are used for RPM in order to optimize care delivery and avoid denied claims.
RPM is covered for Medicare Part B patients with a small co-pay. This monthly program offers patients personalized care plans, continuous care team engagement, and informed condition management.
RPM is reimbursable under Medicare’s Physician Fee Schedule, paying various rates.
Remote monitoring CPT codes correspond to an exact activity, whether that be device setup or providing care services. The codes reflect different rates, each with its own restrictions.
Providers, on average, receive $47.87 for 20 minutes of service per patient per month (99457). Additional opportunities to meet higher billing thresholds are also available. For example, an additional $43.02 per month is billable when patients utilize their RPM device daily (99454).
It is important to note: CPT code 99454 (device use) can be billed every 30 days while codes 99457 and 99458 (program time) are calendar month codes. Aligning claims submissions for these codes is recommended.
We would suggest submitting all RPM-related claims together by calendar month.
Understanding how Medicare calculates physician reimbursement rates is at the center of answering how much Medicare pays for Remote Patient Monitoring. CMS calculates reimbursement rates for RPM services using a variety of factors, including:
The following graphic illustrates the Medicare PFS payment rates formula that is used to establish what physicians and other providers are paid.
RPM is a telehealth program for Medicare Part B beneficiaries. Using digital devices, patients self-collect their physiological data and transmit this information to their provider. Care teams and physicians can then use this data to improve chronic condition management.
For instance, RPM has been shown to be beneficial for hypertension management. Payors are also now investing in RPM-like programs to promote value-based care models. During the pandemic, RPM proved to provide a cost-effective method to monitor and support care for many chronic illnesses.
Physicians are beginning to realize the many benefits that enable them to follow the patient's status and make necessary changes that deliver better condition management.
Any patient covered by Medicare Part B can enroll in RPM and receive 80% coverage. Many secondary insurances will make up the remaining cost.
RPM is billable monthly, considered from the first day through the last day of a month.
RPM devices must meet the Food and Drug Administration’s (FDAs) criteria for a designated medical device. These can include:
As services for RPM are delivered through remote interactions, the appropriate device is provided to the patient and taken home. The device then collects daily readings which are transmitted digitally to the provider.
RPM data can include:
RPM data should be collected through a resource compliant with the Health Insurance Portability and Accountability Act (HIPAA), such as care coordination software.
RPM billing must be directed by a provider with an NPI number. However, clinical staff can administer most of the program, saving physician time and involvement. Eligible providers include:
Five items are required when submitting a Medicare claim:
It is helpful to know the staff care coordinator assigned to a patient in case of an audit.
The 2025 Final Rule says, “We believe the non-face-to-face time required to coordinate care is not captured in the RHC AIR or the FQHC PPS payment, particularly for the rural and/or low-income populations served by RHCs and FQHCs. Allowing separate payment for CCM services in RHCs and FQHCs is intended to reflect the additional resources necessary for the unique components of CCM services.”
This gives RHCs/FQHCs access to individual billing codes aims to improve payment accuracy and provide clarity about which services beneficiaries receive.
CMS is implementing a six-month transition period to enable qualified rural providers to update their billing systems and procedures. The transition is currently set to end on July 1, 2025; however, it could be extended further. Beginning January 1, 2025, RHCs and FQHCs may begin billing individual HCPCS/CPT codes if they so choose.
Providers can offer RPM alongside Chronic Care Management (CCM).
Providers can use CCM to engage patients on a monthly basis between regular appointments. Delivered through remote interactions, either by phone or a telehealth platform, CCM is billable when at least 20 minutes are spent with the patient performing appropriate tasks.
CCM supports its own CPT billing codes, and these can be billed concurrently with RPM, supporting dual reimbursements. However, all CCM service and time requirements must be met separately from RPM.
This is also the case for rural health clinics and federally qualified health centers. These groups must use HCPCS code G0511, though.
Learn more about CCM billing codes here.
For healthcare organizations, care management programs can drive revenue and support cost savings. Below is a general example of how reimbursement for a RPM program could add up.
The final figure does not include billable time beyond the 20-minute minimum, but additional time would increase revenue for your practice.
For example, CPT code 99458 is utilized for additional increments of 20 minutes after the initial 20-minute minimum has been met. It is an add-on code to 99457 and can be billed in unlimited 20-minute increments each month with reimbursement averaging $38.49 each time billed.
As long as the patient is provided with an RPM device, CPT code 99453 can be utilized once per device per patient to help offset device reimbursement.
In addition to creating practice revenue, RPM programs broaden patient care access and can prevent emergency situations through daily monitoring.
RPM programs offer additional provider benefits, beyond direct reimbursement. They can be optimized to report data, engage and motivate patients, and meet specific quality metrics key to value-based care.
RPM enhances patient engagement and improves care coordination. Personalized care planning can be used to establish and track SMART goals, or identify social determinants of health.
Patients benefit from enhanced engagement, as well as access to a care manager. They have a monthly check-in to ask questions, discuss conditions, and access resources.
A RPM program can generate significant revenue just by billing certain CPT codes. However, elements of the program, especially within a larger healthcare system, can also promote a value-based care model.
ThoroughCare gives providers the tools and support to make Remote Patient Monitoring effective.
We help providers, based on their specific needs, build Remote Patient Monitoring programs or scale existing services. ThoroughCare supports a comprehensive software platform, clinical expertise to optimize workflows and assistance with data and reporting for quality improvement.
We simplify the process, so providers can focus on engaging patients. ThoroughCare offers:
*Reimbursement rates are based on a national average and may vary depending on your location.
Check the Physician Fee Schedule for the latest information.