The Centers for Medicare & Medicaid Services (CMS) have established CPT codes for remote patient monitoring (RPM). Here, we break down the codes for you into three categories: setting up RPM, data collection by the device, and review of patient data. This is meant to provide an overview of the codes you will need. We will keep you up to date as new guidelines are released.
Setting up RPM
Setting up a new device for a patient is reimbursed under CPT code 99453 at $21* per instance. This requires a prescription, patient consent, and that the device is able to automatically transmit data to the selected provider. Note that this code can only be reimbursed once per patient per 30-day period, even if the patient is using multiple RPM devices.
Data Collection by Device
CPT code 99454 covers remote monitoring of physiological data with a device, and a reimbursement of $69 can be filed once every 30 days. To use this code, data must be transmitted to the provider or an alert must be sent on at least 16 days in the 30-day period.
Review of Patient Data
There are three CPT codes for review of patient data and communication with the patient: 99457, 99458, and 99091.
99457 provides a $54 reimbursement each calendar month for a minimum of 20 minutes of live communication with the patient by physicians, qualified health care professionals (QHCPs), or clinical staff. There is discussion, as the proposed codes for 2021 (summary) are being reviewed, around changing this to 20 minutes of review and communication. A public comment period is open through October 5, 2020 at 5pm Eastern Time to offer feedback on this change in the CMS guidelines. You can submit comments online here or by mail:
- Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, P.O. Box 8016, Baltimore, MD 21244-8016.
- Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1734-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850
If submitting by mail, be sure to leave enough time for your mail to arrive before the deadline.
99458 is useful if you need to spend more time on a particular patient’s data or communication with that patient. It allows for billing $42 per calendar month for at least 20 minutes of review or communication (on top of the initial 20 minutes) by physicians, QHCPs, or clinical staff.
99091 can be billed $59 once per 30-day period for a minimum of 30 minutes of review patient data only by physicians or QHCPs.
The Nixon Law Group has provided a helpful additional overview of the distinctions among the codes for reviewing patient data.
*All reimbursements listed are based on averages among states.