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RPM Billing: What to Know

For Digital Health, Providers, & Care Teams Maximize your remote patient monitoring (RPM) reimbursement and improve your standard of care with billing CPT codes. With RPM-specific billing codes, you can bill for most RPM services including setting patients up with at-home devices through clinical data monitoring.


When using RPM CPT billing codes, there are a few things you should remember:

  • Devices need to be purchased by a clinical entity (you)

  • To bill for RPM, 20 minutes of interactive communication & care management directly related to your RPM services is required

  • A minimum of 16 days of readings, per month for some codes to be billable

  • Data must flow electronically from patient to provider

  • The provider associated with the RPM service must be able to bill Medicare for E/M services

  • During the PHE, which lasts until January 2022*, non-established patients are eligible

Patient device setup, use, and related care communication can all be billed under RPM CPT codes. Impilo offers device setup and ongoing support to help you get the most out of your RPM billing.


 



CPT code 99453

Setup & patient education on device use **One time use**

$19


This code covers the initial setup and patient education on how to use connected devices, including measurement best practices. 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**

$62


Again, the device must be ordered by a physician or QHP. CPT Code: 99454 is billable every 30 days and covers the cost a provider incurs if they lease or purchase the device for their patient. In 2021, CMS provided clarification that this code requires the patient to submit at least 16 days of device readings during the 30-day period.



CPT code 99457

Remote monitoring of patient data 20 minutes per month. **Once monthly, indefinitely**

$52


This RPM code is used for care management and coordination. Billing for code 99454 requires 20 minutes of patient-interactive virtual care during the calendar month by a qualified healthcare provider or care manager.


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.

$42


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.

 

For help with direct-to-patient device fulfillment or access patient data in real-time from connected devices, reach out to sales@impilo.health.



*Subject to change, please refer to the appropriate US government websites for the most current PHE timeline and guidelines Please Note: All reimbursement amounts are approximate & subject to change