Since 2019, CMS has expanded reimbursement opportunities for healthcare providers by including RPM services. RPM is payable by Medicare and 21 state Medicaid programs (as of January 2021), and an increasing number of private payers.
Below are the 2020 RPM Codes and CMS Guidelines for providing RPM services to patients, as well as for staff time spent monitoring these patients:3-4
99453: Initial setup and patient education for the use of monitoring equipment.
99454: Supply of devices and collection, transmission, and summary of services.
99457: First 20 minutes of remote physiologic monitoring management services by clinical staff/physician/QHCP requiring interactive communication with the patient or caregiver. (20 minutes in a month)
99458: For an additional 20 minutes of remote physiologic monitoring by clinical staff/MD/QHCP requiring interactive communication. (each additional 20 minutes spent beyond 99457 up to 60 minutes total)
99091: Eligible practitioners can bill to receive separate reimbursement “for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider, at a minimum of 30 minutes of time.
*Medicare covers the following services for both new and established patients with acute or chronic conditions.
*Reimbursement amounts will vary based on Medicare administrative contractors. (MACs)
Example first month billing
RPM CPT CODE Reimbursement
PROJECTED REIMBURSEMENT TOTAL $246.19 (represents 80% of billable amount, payable by CMS)
*With a supplement Projected– Total $307.