For Digital Health, Providers, & Care Teams
Curious on 2024 RPM billing guidelines? Boost your reimbursement for remote patient monitoring (RPM) and enhance the quality of care by using specific billing codes. These codes allow you to bill for various RPM services, from setting up patients with at-home devices to monitoring clinical data.
When using RPM CPT billing codes, there are a few things you should remember:
Devices should be acquired by the clinical entity (you).
To bill for RPM, ensure there is 20 minutes of interactive communication and care management directly linked to your RPM services.
Some codes require a minimum of 16 days of readings per month to be eligible for billing.
Electronic data transmission from the patient to the provider is necessary.
The provider associated with the RPM service must have the capability to bill Medicare for Evaluation and Management (E/M) services.
Patient device setup, usage, and related care communication can all be invoiced under RPM CPT codes. Impilo provides device setup and ongoing support to optimize your RPM billing outcomes.
*Please Note: All reimbursement amounts are approximate & subject to change. All numbers provided are averages based on the national payment rate. Refer to the appropriate US government websites for the most current PHE timeline and guidelines.
CPT code 99453
Setup & patient education on device use
**One time use**
The initial one-time setup of each device and educating patients on using equipment for remote patient monitoring, like checking blood pressure, pulse oximetry, and blood glucose. You can use this code once after the first 16 days of monitoring in a 30-day period. CPT code 99453 is a one-time billing code used at initial enrollment in an RPM program at the recommendation of a physician or qualified healthcare professional (QHP).
CPT code 99454
Supplying a patient with an RPM device for a 30-day period
**Once monthly, indefinitely**
CPT code 99454 covers expenses related to providing devices, transmitting data, and collecting and reporting services. You can apply this code once a month per patient, regardless of the number of devices used. The device must be used for at least 16 days a month, and the code is billable every 30 days.
CPT code 99457
Remote monitoring of patient data 20 minutes per month.
**Once monthly, indefinitely**
99457 CPT Code includes the initial 20 cumulative minutes of RPM services provided by a healthcare professional over a 30-day period. Some of this time must involve interactive remote communication with the patient through video, phone, email, or text messages. This code can be billed as 'incident to' under general supervision, allowing collaboration with third-party RPM companies. It is billed once during a 30-day calendar month.
CMS clarified the “interactive communication” element contributes to the total time, but additional activities can contribute to this total. Put another way, the 20-minutes of intra-service work associated with CPT codes 99457 and 99458 includes a practitioner’s time engaged in “interactive communication” as well as time engaged in non-face-to-face care management services during the month.
CPT code 99458
For an additional 20 minutes of monitoring on top of the requisite 20 minutes for the previous “code 99457” per month.
This code (99458) is also a part of the interactive virtual care during the calendar month. However, this code is for additional time spent with the patient. After meeting the requirements for code 99457, healthcare organizations can bill in additional 20-minute increments using code 99458. For example, if a patient gets 40 minutes of virtual care covered by RPM, this code will be used to bill for the incremental 20 minutes.
CPT Code 99091
Remote monitoring of patient data for 30 minutes and 1 instance of communication between provider and patient per month.
*This code cannot be billed in conjunction with 99457 or 99458 for the same billing period.*
CPT code 99091, introduced in 2022, has more stringent requirements. It involves a minimum of 30 minutes per month for clinical staff to gather, interpret, and process patient-transmitted data. Additionally, it covers at least one communication by phone or email, involving medical management or monitor advising.