- Remote patient monitoring, or RPM,
is an exciting new program created by Medicare
to monitor patients' vitals in between visits
using connected devices given to the patient
by the provider.
You can make the most of this program
as long as you know how to bill it correctly.
In this video, we'll break down everything you need to know
about the CPT codes for remote patient monitoring
to help properly bill, and more importantly,
to maximize your revenue.
(bright music)
Hi there, this is Loren with ThoroughCare.
Every day here at ThoroughCare,
we're helping groups just like yours
to help manage and streamline the most tedious
remote patient monitoring processes.
Now CPT codes are broken into two categories
for remote patient monitoring,
device based billing and time based billing.
And there's also a separate code
for our friends at Rural Health Clinics
and Federally Qualified Health centers.
Before we jump into the codes themselves,
let's talk a little bit more about
remote patient monitoring devices.
You may be asking yourself, what exactly is an RPM device?
Now an RPM device is defined as a device
given to the patient by a provider,
and are taken home by the patient to take readings daily.
These devices transmit data electronically
in some form or fashion.
The patient can rest assured that the device reading
will then be sent to the provider's office,
so that provider can make any interventions,
and make sure that the patient's vitals
are within the range expected.
These devices can be, but aren't limited to weight scales,
glucometers, and blood pressure cuffs,
just to name a few.
As far as the device based codes,
the first you'll need to be aware of is CPT code 99453.
This is when the device is given to the patient,
and you explain to the patient
how to properly use this device.
It's really a setup and education code.
So for example, if you give the patient
a blood pressure cuff, you might explain properly
how to adjust the cuff, change batteries,
and make sure the data is being transmitted
to your practice.
99453 is a one time code per device.
It can only be billed once a month,
so if you're giving your patient multiple devices,
make sure you break up billing 99453 from month to month.
For example, in the month of January,
if you give the patient both a weight scale
and a glucometer, you can only bill one 99453 code
for the month of January.
You'll need to wait until the month of February
to bill for the other.
The current average reimbursement for 99453
sits at around $20.
Now keep in mind, these are national average reimbursements.
They may vary in your area.
The other device based code for remote patient monitoring
is CPT code 99454.
99454 is for daily monitoring.
99454 will only trigger once the patient takes
16 readings within a calendar month.
This billing code is also a one time per month code,
no matter how many devices the patient is given.
If the patient does have multiple devices,
you can total the readings from those two devices
to be taken into account for the 16 total days
with readings.
99454 pays at about a national average reimbursement of $56.
Now that we know about device based codes,
let's talk about time-based remote patient monitoring codes.
CPT code 99457 will allow you to bill
for 20 minutes of non face to face interaction
around the remote patient monitoring program.
To bill for 99457, 20 minutes need to be accrued
by a clinical member or hire of your staff.
So think a certified medical assistant,
or a certified nurse's assistant, or higher.
These non face to face interactions, or RPM time categories,
might include daily monitoring, phone calls,
referrals, prescription refills,
or basically anything your clinical team is doing
while the patient is out of the office.
99457's national average reimbursement is
at about $52 per month.
There is also an add-on code to 99457 known as 99458.
This can only be billed concurrently with 99457,
and it takes into account additional 20 minutes
over the initial 20 minutes.
This code pays at about $40 over the initial $52,
and can be billed as many times as you'd like per month.
So think 40, 60, 80 plus minutes.
Now let's talk about remote patient monitoring
for Rural Health Clinics
and Federally Qualified Health Centers.
For Rural Health Clinics
and Federally Qualified Health Centers,
there's some confusion on whether or not
these types of clinics can bill for RPM services.
Unfortunately, Medicare has made the aforementioned codes
unavailable to these types of providers.
The fact is, though, that you can still bill
for remote patient monitoring
using general CPT code G0511.
This code usually is seen more with chronic care management
or behavioral health integration, but you can still bill
for 20 minutes of RPM time using the code G0511.
Our suggestion is to give the patient
a remote patient monitoring device,
log the 20 minutes, and bill for code G0511.
Using code G0511, the national reimbursement for FQHCs
and RHCs is $76.94.
Code G0511 cannot be billed more than once a month.
So if you are billing for CCM and RPM,
you can only choose one or the other.
Now that you have a better understanding
of the remote patient monitoring CPT codes,
you might want to take a deeper dive
on whether or not this program is right for your group.
There's a link in the description below
to our learning center, filled with clinical written content
by our clinician team on staff
regarding the value based programs that ThoroughCare offers.
Or if you'd like to learn more about
care coordination software,
feel free to contact us any time.
If you have any question, comments, or concerns,
Feel free to write in the comments below.
Don't forget to subscribe and like this video.
Thanks for watching.
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