CMS Remote Patient Monitoring CPT Codes – 2021 Proposed Changes

By August 19, 2020 Blog

Over the past two years, the Centers for Medicare and Medicaid Services (CMS) have created and amended codes allowing for remote patient monitoring (RPM) reimbursement. The codes account for clinical time spent measuring and reviewing physiological data, such as weight, blood pressure, pulse oximetry and respiratory flow rate, remotely or outside of traditional clinical settings (usually between clinical visits). And, in the wake of COVID-19, certain guidelines were expanded to provide more flexibility, allowing practitioners to offer care more easily to patients at home, while freeing up critical hospital resources.

On August 3rd, 2020, CMS issued clarifications and proposed changes to the RPM services.

At Clear Arch Health, we have worked with healthcare organizations, providers, and other clients to develop and implement successful RPM programs. Doing so has provided valuable insight and given us the opportunity to help our clients leverage these reimbursement codes. There are five primary Medicare RPM codes (CPT codes 99091, 99453, 99454, 99457, and 99458) and they are outlined in the graph below.

Available CMS Codes for 2020 RPM Reimbursement

Code

Description

CPT99091

 

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.
CPT 99453 Initial; set-up and patient education on use of equipment. This is for the monitoring of parameter(s) such as respiratory flow rate, blood pressure, pulse oximetry, blood pressure).
CPT 99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
CPT 99457

Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time. This code requires interactive communication with the patient/caregiver during the month.

CPT99458 Monitoring of remote physiologic that exceeds first 20 minutes of RPM services (for clinician)

Nathaniel Lacktman, Partner of Foley & Lardner, LLP and Chair of the Telemedicine & Digital Health Industry Team, continues to closely monitor CMS changes. He put together the Top Ten Medicare Remote Patient Monitoring FAQs for 2021 to help summarize the proposals and clarification statements in the CMS 2021 Proposed Rule. We have summarized some of the questions and responses below:

1) What is remote patient monitoring?

RPM allows clinicians to monitor and manage the health of a patient while at-home or outside of a clinical setting. A patient will take their vitals, using a connected health device such as a pulse oximeter or blood pressure monitor, and once a reading has been recorded, the data will transmit to a communication hub. The patient’s clinical team will be able to collect, review, and analyze the patient’s vitals and adjust their treatment plan and/or intervene as needed.

The data captured is called physiological data (i.e. weight, blood pressure, pulse oximetry and respiratory flow rate).

2) Must the patient have a chronic condition to qualify for RPM?

The clarifications from the 2021 Proposed Rule have expanded the codes allowing for clinicians to not only remotely collect and analyze data from patients with chronic conditions, but also those with acute conditions. Learn more.

3) Can RPM be used with new and established patients, alike?

This information has also been clarified in the 2021 Proposed Rule and is limited to “established patients.” For further information, see Foley’s FAQ.

4) Who can order and bill for RPM services?

Physicians or non-physician practitioners who are eligible to bill for Evaluation and Management (E/M) services can order and bill for RPM services.

5) How many days must the RPM device monitor per month?

To bill for CPT codes 99453 and 99454, monitoring must occur over at least 16 days of a 30-day period. Refer to Foley’s FAQ for details.

Comments regarding the 2021 Proposed Rule are currently being accepted until September 30th. Learn more here.

To learn more about RPM trends, how to utilize CPT codes to build a better patient care model, and how to develop a successful program, with little to no capital investment, watch this brief webinar.