FAQ

Remote patient monitoring (RPM) is a healthcare delivery method that uses digital technologies to monitor and analyze a patient’s health metrics outside of a traditional clinical setting. RPM technology electronically transmits health information between patients and providers. This type of monitoring is often used to manage and care for high-risk patients, such as those with acute or chronic health conditions.

RPM provides a wide range of benefits, including:

• Improved management of acute and chronic conditions
• Reduced hospitalizations and readmissions
• Lowered overall healthcare costs
• RPM helps reduce the risk of infectious disease exposure such as COVID-19 for patients, providers and healthcare workers.

RPM technology allows for the maintenance of the “Remote COVID world” as we see the crucial role technology plays in healthcare today. Remote monitoring helps keep patients safe, and out of the hospital.

RPM can be ordered and provided by physicians or nurse practitioners (The ordering physician is not required to be the PCP). Clinical staff can deliver and manage RPM under the general supervision of the billing provider.

Any patient with a chronic or acute condition may receive RPM services if the provider prescribes/orders RPM and it is supportive to managing or improving the patient’s condition.

Yes, CMS allows providers to deliver RPM services to new and established patients for both acute and chronic conditions.

The RPM device must be necessary for the diagnosis or treatment of the patient’s condition. It must or be used to gather and transmit data. RPM can employ wireless or wired measurement devices. Typically, these devices are Bluetooth blood pressure monitors, weight scales, pulse oximeters and blood glucose meters.

Providers may use RPM to collect patient health data, including blood pressure, heart rate. Heart rate variability, vital signs, weight, blood sugar levels, blood oxygen levels, and physical activity.

Specialties that utilize RPM include but are not limited to internal medicine, primary care, nephrology, cardiology, pulmonology, endocrinology, gastroenterology, and bariatrics.

Some of the most common conditions that can be managed by RPM include hypertension, obesity, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, and diabetes.

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
99453                                      $21.00
99454                                      $69.00
99457                                      $54.00
99458                                     $43.00
99091                                     $59.19 

PROJECTED REIMBURSEMENT TOTAL $246.19 (represents 80% of billable amount, payable by CMS)

*With a supplement Projected– Total $307.  

Yes 

There is no copay with a supplemental policy or Medicare part B with a supplement. In addition, many private insurers are currently reimbursing for RPM.

References 

• ‌ Life after COVID: Remote patient monitoring will be even more critical. (2021, September 1). McKnight’s Long-Term Care News. https://www.mcknights.com/blogs/guest-columns/life-after-covid-remote-patient-monitoring-will-be-even-more-critical/
• Medicare Remote Patient Monitoring Reimbursement FAQs: Everything You Need to Know About Chronic Care Remote Physiologic Monitoring Codes | Blogs | Health Care Law Today | Foley & Lardner LLP. (n.d.). Www.foley.com. Retrieved November 5, 2021, from https://www.foley.com/en/insights/publications/2018/11/medicareremote-patient-monitoring-reimbursement-fa
• ‌New Reimbursement for Remote Patient Monitoring and Telemedicine. (2017, November 3). C&M Health Law. https://www.cmhealthlaw.com/2017/11/new-reimbursement-for-remote-patient-monitoring-and-telemedicine/