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RPM enables daily measurement of patient health data, including vitals. Providers can assess and use this information to monitor trends and inform long-term care of chronic conditions.
Along with ongoing data analysis, RPM includes monthly access to care management services, such as:
Remote Patient Monitoring presents a unique opportunity for patients not seen previously in healthcare.
Technology-based monitoring and engagement in the home allow patients to experience stronger access to providers. They're given more continuous oversight and care, timely interventions, and convenience and security.
Remote monitoring data can enhance care for, but not limited to:
RPM billing must be directed by a provider with an NPI number. That said, a diverse set of licenses can deliver the program, including:
Enrollment is completed at an in-person evaluation or Annual Wellness Visit. Written or oral consent must be documented.
The provider should explain to the patient:
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 $48.14 for 20 minutes of service per patient per month (99457). Additional opportunities to meet higher billing thresholds are also available. For example, an additional $46.50 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.
Before starting a program, it's important to consider:
Apart from understanding RPM's rules and requirements, providers should:
Organize a multidisciplinary team of qualified providers to support a comprehensive RPM program, and determine appropriate roles and responsibilities.
Find eligible RPM patients by targeting specific conditions or populations, working with specialists and primary care partners, or reviewing current EHR records.
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Acquire a digital platform to streamline workflow, support documentation, capture and interpret data, enable patient care planning, track and report outcomes, and automate claims preparation.
RPM data can include:
RPM data should be collected through a resource compliant with the Health Insurance Portability and Accountability Act.
Data collected and analyzed by Definitive Healthcare indicate that cardiologists and primary care physicians are the main RPM adopters, with nephrologists, pulmonologists, emergency medicine, and pain management specialists making up a smaller but influential group.
Conditions like heart disease, diabetes, and chronic lung disease are not only the deadliest chronic illnesses in the US, but the most prevalent monitored via RPM.
In the specialist care setting, RPM devices can target specific conditions and clinical measures.
RPM data provides an early detection alert when a patient’s clinical picture worsens, but symptoms haven’t surfaced yet.
An adult oncology hospital-at-home program found that during the first 30 days of enrollment, patients in the program were 58% less likely to be admitted for an unplanned hospital stay.
For rural health clinics, RPM helps fill gaps in care. Research demonstrates RPM’s efficacy in rural settings, particularly for diabetes, heart failure, and chronic obstructive pulmonary disease (COPD).
An RPM program can also capitalize on providers’ strengths in nurturing personal relationships and maximizing limited resources. They can leverage close ties to the community and collaborate toward quality improvement efforts.
Rural health clinics and federally qualified health centers utilize this HCPCS code for "general care management” to bill for Remote Patient Monitoring.
This code can be billed for multiple care management services per month, including Chronic Care Management and Behavioral Health Integration. However, all service requirements and accounting must be met separately.
RPM supports preventative care management between office visits, demonstrating improved outcomes over episodic, reactive disease treatment approaches.
Enrollment in RPM provides patients access to individual care planning, monthly touchpoints with the greater care team, referral services, prescription refills, and physician reviews.
Providers can use RPM programs to seamlessly coordinate care.
Since 2017, ThoroughCare has helped MetaPhy Health optimize care delivery for patients with multiple chronic conditions.
Learn how MetaPhy Health uses our care coordination platform.
This can further support patient outcomes and generate additional reimbursement.
Manage conditions with SMART goals, care plans, and evidence-based assessments.
Providers can help address behavioral health as part of overall care for chronic illness.
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Patients can receive support following a hospital discharge to avoid readmission.
Capture and analyze patient health data continuously to inform condition manage, monitor risks, and report and track overall wellness.
Our software platform is intuitive and designed for RPM’s rules and requirements. ThoroughCare can help:
