Remote Patient Monitoring
Rules and Requirements

Better understand the Medicare requirements
to improve your RPM program
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What is RPM?

Remote patient monitoring (RPM) uses digital technologies to collect and track a variety of patient health data outside of traditional healthcare settings.

The data is electronically and securely transmitted to health care providers for assessment and recommendations.

To capture the data, RPM can employ a variety of wireless devices such as blood pressure cuffs, biosensors, glucometers, and more.

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Coding and Billing

Below is a breakdown of the reimbursement structure your practice can use for 2021:
 
Code 99453: $21.00
For initial setup and configuration of devices, and educating the patient on using the device(s).
 
Note: For code 99453, you may only bill that once per device. You would not be able to bill 99453 twice in one month, even if you gave the patient two devices that month.

Code 99454: $65.00
For the provided device with daily monitoring of physiological data.
 
Note: Code 99454 may only be billed once, no matter how many devices the patient is using.






Code 99457: $54.00 

For 20 minutes of clinical staff/physician/other qualified health care professional time and management of care in a calendar month.

Code 99458: $22.01 
For an additional 20 minutes of care in a calendar month (40 minutes total)

For 40 minutes of RPM care, you would bill 99457 ($54.00) plus 99458 ($22.01) for a total of $76.01.

*reimbursement based on national averages

Who Can Receive RPM Care?

The Centers for Medicare and Medicaid Services (CMS) designated RPM is only for established patients.

Note: Due to the Public Health Emergency (PHE) brought on by the COVID-19 pandemic, CMS has relaxed this rule so that RPM can be delivered to both new and established patients for as long as the PHE is in effect.

How many days of monitoring?

CPT code 99454 is billed for the provided RPM device with daily monitoring for a total of $65.00 per patient per month. 16 days of readings are required in order to bill for 99454 or 99453.

Note: CMS has stated that while the PHE is in effect, a minimum of only 2 days is required to bill for 99454.

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