Remote Patient Monitoring 2023 CPT Codes: A Complete Guide to Reimbursement & Examples
Are you searching for a listing of 2023 remote patient monitoring CPT codes and reimbursement rates? As healthcare providers know, Centers for Medicare, and Medicaid Services (CMS) update RPM CPT billing codes yearly to incentivize more practices to implement RPM for their patients. The 2,000 plus page document includes updates for remote patient monitoring CPT codes and reimbursement guidelines. The concise guide provided here shows the most up-to-date RPM CPT codes, reimbursement costs and billing requirements.
The Specifics of Remote Patient Monitoring CPT 2023 Codes
The following sections provide an overview of what the 5 CPT codes cover in 2023, including average reimbursement rate and requirements.
This CPT code covers device set-up and patient education on use of equipment for vital sign monitoring such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate and weight. Furthermore, this one-time code is billed after the initial 16 days of monitoring. The average national payment rate for CPT 99453 is $19.
CPT 99454 pays for supplying the device for daily recording or programmed alert transmissions. Unlike the prior CPT 99453 code, CPT code 99454 may be used more than one time, given the patient uses the device at least 16 days per month. In addition, CPT 99454 is billable every 30 days. The average national payment rate for this code is $49.
Code 99457 is comprised of initial 20 minutes of treatment management. An unspecified portion of that 20 minutes must involve interactive remote communication with the patient. There is no explicit explanation of how interactions must be provided. It is assumed that a video call, phone call, email, and text messaging all suffice. The average national payment rate for this code is $48.
Moreover, CPT 99457 is be billed ‘incident to’ under general supervision. This means that Medicare providers can contract third-party RPM companies to assist with RPM services. Ultimately, offering providers the opportunity to manage more patients. Thus resulting in more company revenue without significantly impacting workflow. CPT 99457 is billed monthly.
CPT 99458 encompasses reimbursement for each additional 20 minutes of RPM services, with a maximum of 60 minutes in a calendar month. Similar to CPT 99457, documentation of how the time is distributed is required. The average national payment rate for CPT 99458 is $39.
This is the newest code, which was introduced in 2022. It has more requirements that the preceding codes. It covers a minimum of 30 minutes in a calendar month for the time it takes clinical staff to gather, interpret and process data that is transmitted by a patient. It also covers at least one communication, occurring by phone or email where medical management or monitor advising occurs. The average national payment rate for CPT 99091 is $53.
Billing Requirements for Remote Patient Monitoring
Presently, all Medicare beneficiaries are eligible to participate in remote patient monitoring; however, there are some requirements. A summary of the requirements to bill for remote patient monitoring CPT codes in 2023 are as follows:
- Medical device must fit within the FDA’s definition of a medical device
- Patient needs to opt-in for the service before the device is ordered
- Device must be used by the patient for at least 16 days a month
- Data collection must be HIPAA-compliant
Ready to Try Remote Patient Monitoring?
In summary, Medicare recognizes that remote patient monitoring plays a significant role in the future of healthcare. By implementing remote patient monitoring technologies into the workflow, clinicians can improve quality of care and generate more revenue.