Remote patient monitoring (RPM) is an important branch, strong augmentation and considerable expansion of telemedicine that has altered the health business.

RPM has played a significant part in reducing the risk of Covid-19, and as a result, it has emerged as a viable alternative to in-person medical examinations. Medical practitioners may now manage patients with chronic diseases from their own homes thanks to remote patient monitoring, which has become a common term.

Specific RPM CPT codes, on the other hand, are frequently used to motivate doctors and promote remote patient monitoring. CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 9909 are some of the rpm billing codes. But what exactly are these codes, and how do they feature? We’ll discuss it in this post.

What are Current Procedural Terminology (CPT) codes?

CPT codes are five-digit numerical codes without a decimal point, while some also include one letter and four numbers. These are numbers allocated to each task and service that a healthcare provider does. They’re employed to bill and track medical services and assigned to various tasks.

Surgical, medicinal, and diagnostic procedures are among the current Procedural Terminology codes which insurers use to decide how much they must pay a provider.

To promote uniformity, CPT codes are the same for everyone everywhere. Some are widely used, while others are rarely used. The codes 99214 and 99213, for example, are general checkups that are frequently used.

These codes, however, do not provide a universal definition of healthcare for everyone. They also don’t guarantee that different healthcare providers get compensated for their services in the same predetermined amount: such complexities are usually spelled out in the contracts between insurers and healthcare providers.

The Healthcare Common Procedure Coding System (HCPCS) codes are quite close to CPT codes; however, they are not identical. In their papers, people that use Medicare use HCPCS codes rather than CPT codes. The American Medical Association is responsible for maintaining, developing, and copyrighting CPT codes (AMA). New codes are allocated to new services regularly, existing codes are changed, and old codes are discarded.

What role do CPT codes play in reimbursement for remote patient monitoring?

CMS developed five primary CPT codes to encourage more healthcare providers to use remote patient monitoring and enhance their revenue streams. The following are the five key CPT codes for Remote Patient Monitoring reimbursement:

• CPT 99453,
• CPT 99454,
• CPT 99457,
• CPT 99458, and
• CPT 99091

The Service Codes for RPM are CPT codes 99453 and 99454, respectively.

CPT Code 99453

CPT Code 99453 was created to help patients who aren’t tech-savvy, can’t navigate their phones, or have trouble utilizing medical devices. This service code helps individuals receive training on using these devices and compensates medical health providers for providing these services to patients.

Because the Centers for Medicare and Medicaid Services (CMS) does not reimburse for the pieces of equipment, this includes the time spent on patient education or onboarding. This code covers the RPM enrolment service code, which is reimbursable.

CPT Code 99453 can only be billed once when it is first set up. The same healthcare provider or National Provider Identifier (NPI) number cannot be used twice.

CPT Code 99454

After a patient has been enrolled in RPM and monthly services have begun, CPT Code 99454 is used. CPT Code 99454, which is used to alert transmissions and report the administration of healthcare devices for health-related data, is reimbursable for these services. The programming and delivery of health-related devices are covered by CPT Code 99454.

CPT Code 99457

CPT Code 99457 reimburses for up to 20 minutes per calendar month spent remotely monitoring physiologic measures such as weight, blood pressure, respiratory flow rate, pulse oximeter, etc. It also includes management services and time spent in interactive communication sessions with patients or caregivers by physicians, clinical staff, and other certified healthcare professionals during the month. The billing cycle for this code is once per calendar month.

CPT Code 99458

CPT Code 99458 is a monthly add-on code for CPT Code 99457 that reimburses health care professionals for each additional twenty minutes of interactive monitoring sessions. Each calendar month, this code can be billed up to two times.

CPT Code 99091

Although CMS still considers CPT Code 99091 valid, the codes listed above better depict the numerous medical circumstances requiring billing. It is limited to data acquired over the course of 30 days and cannot be billed in the same month as CPT Codes 99457 and 99458.

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