Medicare RPM FAQs for 2020

RPM: The Basics

What is RPM?

RPM involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition. The four primary Medicare RPM codes are CPT codes 99453, 99454, 99457, and 99458.

Is RPM new?

In short, RPM is not new. However, with recent updates beginning January 2019, CMS allowed providers to be reimbursed for time spent collecting and interpreting physiologic data that is generated by a patient remotely, digitally stored, and transmitted to the provider for review (CPT code 99457). CMS also began reimbursing for time spent educating the patient, setting up the monitoring devices, and the cost of the devices (CPT codes 99453 and 99454).

In January 2020, CMS created an add-on code for RPM (99458) which allowed additional reimbursement for treatment management service time. RPM was also designated as a care management service, with the ability to be furnished under general supervision.

How does RPM work?

RPM involves the use of a device that collects patient data and transmits it wirelessly to a provider. Patients can take vital sign readings (such as blood pressure, heart rate, and body weight) at home. The collected data allows a provider to monitor changes in patient vital signs and act accordingly.

Reimbursement

Which CPT codes are used for RPM reimbursement?

99453 ($16.22) — Initial set-up: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.

99454 ($53.65) — Device: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

99457  ($48.08) — 20 minutes of monitoring per month: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

99458 ($40.04) — Additional 20 minutes per month: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.

How are providers reimbursed for RPM?

Medicare reimbursement rules compensate providers for prescribing and reviewing data that is produced by monitoring devices that capture/store/transmit patients’ physiological data and subsidize the device/service costs. Every month, providers can receive reimbursement for codes 99454, 99457, and 99458 by meeting the above requirements. In addition, there is a one-time reimbursement for setup and patient education (99453).

How does RPM benefit providers?

The benefits include:

  • Increased clinic revenue
  • Improved outcomes for the patient
  • Outcomes to support value-based contracts

Who can provide RPM services?

The CPT codes for RPM services allow physicians, qualified healthcare professionals, and clinical staff to perform RPM. As of 2020, RPM can occur under general rather than direct supervision, which means providers can outsource monitoring and billing duties to third party companies.

What are the requirements for 99453 (device set-up) and 99454 (device supply)?

99453: The device used to capture a patient’s physiologic data must meet the FDA definition of being a medical device in order for CPT code 99453 to be billed. The CPT code descriptor does not indicate that the device must be an FDA approved device.

99454: The CPT language indicates that monitoring must occur over at least 16 days of a 30-day period in order for CPT code 99454 to be billed.

CMS stated that these two codes are not to be reported for a patient more than once during a 30-day period.

Summary of RPM Billing Requirements:

  • Patient must opt-in for the service.
  • Device must meet the FDA’s definition of medical device.
  • Device must be supplied for at least 16 days to be applied to a billing period.
  • Service must be ordered by a physician or other qualified healthcare professional.
  • Data must be wirelessly synced where it can be evaluated.
  • Data-monitoring services may be performed by the physician, by a qualified healthcare professional or by clinical staff. Clinical staff may include RNs and medical assistants, depending on state law.

Enrollment Requirements

Who can order and bill for RPM services?

RPM codes are considered Evaluation and Management (E/M) services. CMS stated they can be ordered and billed only by physicians or non-physician practitioners who are eligible to bill Medicare for E/M services.

Must the patient have a chronic condition to be eligible for RPM?

CMS initially described RPM as services furnished to patients with chronic conditions. However, in the 2021 Proposed Rule, CMS clarified that providers may furnish RPM services to remotely collect and analyze physiologic data from patients with acute conditions, as well as from patients with chronic conditions.

How often does patient consent need to be captured?

As of 2020, CMS has stated that a single annual consent for services must be obtained. Verbal consent is acceptable, and should be documented in the patient’s medical record.

Is there a requirement for face-to-face visits for RPM reimbursement?

CMS does not specify that a face-to-face exam or interactive audio-video chat is necessary for reimbursement.

Can RPM be used with new and established patients, alike?

Patients who have not seen their provider within one year must have an in-person visit before RPM billing may occur. Physicals and annual exams, traditional care management services, and evaluation and management (E/M) services can count, since they have separate Medicare billing codes.

Note: Starting March 1, 2020 and for the duration of the Public Health Emergency (PHE), RPM services can be furnished to both new and established patients (CMS). When the PHE ends, CMS will require that RPM services must be furnished only to established patients. CMS’ waiver suggests that during the PHE, practitioners may render RPM services without first conducting a new patient E/M service.

Veta Health’s turnkey RPM solution gives physician practices the ability to take advantage of RPM billing opportunities while also achieving success in quality and outcome measures under value-based arrangements.

To learn more about what Veta Health can do for your practice, please contact us here.