RPM Reimbursements in 2021

RPM Reimbursements in 2021

Federal Register, the Centers for Medicare & Medicaid Services has amended the 2021 Physician Fee Schedule to clarify reimbursement for remote patient monitoring (RPM) programs.

In the final rule, to qualify for reimbursement under CPT codes 99457 and 99458, CMS mandated at least 20 minutes of interactive communication time between provider and patient over a calendar month, but that interactive communication couldn’t be part of the 20 minutes of RPM care. The agency has now clarified that “interactive communication” can include both in-person and connected health channels.

RPM Reimbursements CPT Codes

CPT Code 99453

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment

This code represents the initial setup and patient education on how to use connected devices as well as best practices on when to take measurements.

CPT Code 99453 covers one-time reimbursement for the time spent setting up a remote monitoring device and teaching the patient how to use it, as well as any additional services needed to enroll the patient on-site. Providers may bill for this code once every 30 days and once per episode of care, but they must record at least 16 days of readings within that 30-day billing period.

CPT Code 99454

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

CPT Code 99454 can be billed monthly and reimburses healthcare providers for the cost of leasing a connected home health care device for a patient, as well as the cost of the software needed to run it. The device must be a leased item that was ordered by the patient’s physician or qualified healthcare professional (QHP) and must not have been previously owned by the patient. It must also be intended for home use and must automatically upload the patient’s health data to their care provider each day.

CPT Code 99091

CPT Code 99091 is the collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional. To bill for CPT Code 99091, the initial provider service must occur in the physician’s office or other applicable sites.

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