Like many aspects of our lives, the COVID-19 pandemic has reshaped how patients seek out and receive medical care. This shift and patients’ reticence to attend office visits in-person has taken an economic toll on small practices across the country. From an American Medical Association survey in July and August 2020, more than three-quarters of respondents had a drop in revenue compared to pre-pandemic with practice revenue falling by an average of 32%. Of those surveyed, almost one in five saw a decrease in revenue of over 50%.
Reimbursements available for using remote patient monitoring (RPM) provide a way for practices to increase their revenue, filling in the gap created by the pandemic. Additionally, RPM offers a tool to keep track of patient health without risking COVID-19 exposure and facilitates the collection of important physiological data. During the public health emergency (PHE), which is expected to continue through the end of 2021, the Centers for Medicare and Medicaid Services (CMS) have made it possible for health care providers to prescribe RPM for new patients. This does not require an in-person visit, making it easier for patients who cannot access the office or are wary of public spaces to receive care.
Reimbursements from RPM usage with patients on Medicare amount to an average of $1,470 per patient annually. For a practice with 50 eligible patients, this means reimbursements total about $74,850 per year. This can be a sizable addition to your practice and offers a source of income during the pandemic when many patients are hesitant to participate in in-person care.
How do RPM reimbursements work?
The average annual revenue from a patient using RPM comes from five CPT Codes that govern the reimbursements.
- 99453 can be billed $20* per instance for setting up a new RPM device for a patient. This device must be able to automatically transmit data to the selected provider in order to qualify. An NP, PA, or MD orders RPM services. Then, either the practice or an RPM365 Care Coach helps to get the patient started with the device. Note that this code can only be reimbursed once per patient per 30-day period, even if the patient is using multiple RPM devices.
- 99454 covers the collection of physiological data with an RPM device, and a reimbursement of $66* can be filed once per 30-day period. To use this code, data must be transmitted to the provider or an alert must be sent on at least 2 days in the 30-day period during the PHE. Once the PHE ends, the patient engagement requirement will return to 16 or more readings per 30-day period. With RPM365, a Care Coach can check in with patients to remind them to take readings to fulfill the requirements for reimbursement.
- 99457 allows for a $52* reimbursement each calendar month for at least 20 minutes of review, including live, “interactive communication” with the patient by physicians, qualified health care professionals (QHCPs), or clinical staff. This time can include time for “furnishing care management services” according to CMS, and an RPM365 Care Coach can provide this service under the “general supervision” of the ordering healthcare professional.
- 99458 can be billed for an additional 20 minutes of time spent in communication with that patient, or for “furnishing care management services,” as for 99457. It allows for a $42* reimbursement per calendar month for a minimum of 20 minutes of review or communication by physicians, QHCPs, clinical staff, or RPM365 Care Coach.
- 99091 provides reimbursement for a minimum of 30 minutes of reviewing patient data only by physicians or QHCPs. It can be billed for $58* once per 30-day period and might be especially helpful when a patient first starts RPM and more thorough data analysis is necessary to develop a treatment plan. To bill this code in addition to 99457, a clear record must be kept documenting that the time billed for each code was entirely distinct. Direct communication with the patient is not necessary to bill this code.
Our platform, RPM365, will provide a monthly reimbursement summary for each patient to facilitate a streamlined billing process. Further details on the usage of these CPT codes are available from DocsInk.
Additional sources of funding
The FCC announced in early February that its COVID-19 Telehealth Program will provide a second round of funding for eligible healthcare providers covering the costs of their telehealth and RPM services. The new application has not opened as of the writing of this piece, but is expected to be available soon.
*CPT code information is based on 2021 definitions. Rates listed are rounded national non-facility averages and ranges by MAC Locality as of 01/20/2021.
