Remote Physiological Monitoring (RPM) is a service utilizing a medical device as defined by the FDA to electronically collect a wide range of health data, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate, electrocardiograms, etc. The data is then transmitted to health professionals in facilities. This type of service allows a provider to continue tracking healthcare data for a patient once released to home or a care facility, reducing readmission rates.
CPT code 99453: Initial setup and Patient Education
Billed when clinical staff set up remote patient monitoring devices and educate the patient on the use of the equipment. This code allows healthcare providers to be reimbursed for the time spent on the initial setup and patient education, ensuring the patient understands how to use the equipment properly and benefits from the remote monitoring services.
CPT code 99454: Device/transmission fee
Billed to cover the cost of supplying the patient with the remote monitoring devices and the transmission of daily recordings or programmed alerts over a 30-day period. This code allows healthcare providers to be reimbursed for the ongoing remote monitoring services, which can help improve patient outcomes and reduce healthcare costs by detecting potential issues early and managing chronic conditions more effectively.
CPT code 99457: REMOTE PHYSIOLOGIC MONITORING TREATMENT MANAGEMENT – first 20 minutes
Billed for the first 20 minutes of clinical staff/physician/other qualified health care professional time spent on remote physiologic monitoring treatment management services in a calendar month. This code allows healthcare providers to be reimbursed for the time spent interacting with the patient and/or caregiver to provide clinical guidance, adjust treatment plans, and ensure the patient is managing their condition effectively using the remote monitoring data.
CPT CODE 99458: REMOTE PHYSIOLOGIC MONITORING TREATMENT MANAGEMENT – each additional 20 minutes
Billed for each additional 20-minute increment of clinical staff/physician/other qualified health care professional time spent on remote physiologic monitoring treatment management services in a calendar month, beyond the initial 20 minutes covered by CPT code 99457. This code allows healthcare providers to be reimbursed for the extra time spent on managing the patient’s condition and addressing any concerns or changes in the patient’s status, ensuring the patient receives the necessary care and support to manage their health effectively.
The applicable codes are provided based on information from third-party sources and are subject to change without notice. The applicable codes are for convenience only and do not constitute reimbursement, legal, or clinical recommendation. The physician’s office should bear the responsibility to determine medical necessity for billing appropriate codes. Please refer to patient’s insurance provider to specific policies to determine payment policies alongside medical necessity guidelines and authorization requirements.