CMS Remote Patient Monitoring & improving patient outcomes

08/12/2021

You’ve probably heard the acronym RPM, but how much do you know about Remote Patient Monitoring? RPM, like other CMS care management programs, is designed to improve patient outcomes while reducing total Medicare spend. Learn the basics of this covered service.

What is RPM?

Remote Patient Monitoring is the use of technology that allows patients to gather personal health data and transmit it to their healthcare professional for review and analysis. The benefits of RPM are that patients with chronic and acute conditions can be regularly monitored from home or other convenient locations. The additional health data equip healthcare professionals to act proactively on behalf of their patients, resulting in fewer complications and hospitalizations.

What type of technology can be used for RPM?

The devices used for RPM must be certified by the Federal Food, Drug, and Cosmetic Act as “medical devices.” The devices must automatically upload and transmit recordings or alerts of patient data and be reasonably necessary for the diagnosis and/or treatment of the patient’s chronic or acute condition.

How is RPM billed?

Remote Patient Monitoring is covered under the CMS Medicare Physician Fee Schedule. Eligible practitioners may bill for the service under the following CPT codes:

99091 – Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days

99453 – Initial patient setup and education on the equipment to be used for remote monitoring of physiologic parameters

99454 – Remote monitoring of physiologic parameter(s) (eg, weight, BP, pulse ox, etc.), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.99457

99457 – Remote physiologic monitoring treatment management services, 20+ mins of healthcare professional time in a calendar month requiring interactive communication. 

99458 – Additional 20 minutes of care management and treatment. Same requirements as 99457.

Appropriate documentation of services should be recorded in the patient’s medical record.

Find the reimbursement rate in your area at the following link: https://www.cms.gov/medicare/physician-fee-schedule

Does a patient have to consent to RPM?

Yes, practitioners must obtain verbal or written consent prior to initiating RPM and the consent must be recorded in the patient medical record.

Can RPM be billed with other care management services?

Yes, RPM can be billed concurrently with Behavioral Health Integration services (BHI), Chronic Care Management (CCM), and Transitional Care Management (TCM), but the time spent for each service must be independent (i.e., no overlapping time should be counted).

How do I learn more about RPM?

There are many intricacies and nuances to RPM and launching a successful program. For a detailed overview of technology options, clinical value, and other features and benefits of RPM, schedule a demonstration at https://carepointe.com/demo/.