• Kendall Paulsen

2020 Remote Patient Monitoring Reimbursement Overview

Updated: Mar 26

Some Background History

In 2018, the Centers for Medicare and Medicaid Services (CMS) proposed three billing codes be added to the physician fee schedule for remote physiologic monitoring. These codes became active in January 2019, and enabled providers to receive reimbursement for remote patient monitoring technology and associated treatment management services.


Beginning January 2020, CMS created an add on code for RPM which allows for additional reimbursement for an additional twenty minutes of treatment management service time. Service components of RPM were also designated as care management services, with the ability to be furnished under general supervision. This enables services to be provided by auxiliary personnel, which are billed to Medicare under the billing provider’s NPI. Auxiliary staff do not need to be located in the same physical building as the billing provider, but do require a direct contractual relationship with the provider.


Revenue Opportunity

Providers can earn $155+ per patient per month with remote patient monitoring reimbursement codes. You can test our remote patient monitoring reimbursement calculator, to view the potential reimbursement opportunity.


Code Parameters

  • Patient consent to the program must be recorded in medical record, there is also a 20% co-pay as a Part B service (can also bill secondary insurer for co-pay, if patient has available)

  • Patients who are new, or who have not been seen for one year, need to undergo a face-to-face visit with billing provider

  • Requires the use of a medical device as defined by the FDA

  • Ordered by a physician or other qualified healthcare professional

  • Treatment management services are to be provided by physician / staff / other qualified healthcare professional (subject to state law scope of practice and supervision requirements)

  • Data must be wirelessly synced for evaluation


CPT: 99453

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate),initial; set-up and patient education on use of equipment


Reimbursement (national): Facility $18.77; Non Facility $18.77


Reimbursement available for initial set-up, onboarding, and training of technology and equipment. One time reimbursement, it can be billed “once per episode of care.” Patient must be monitored for at least 16 days before reporting.


CPT: 99454

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days


Reimbursement (national): Facility $62.44; Non Facility $62.44


Provides reimbursement for the supply of the remote monitoring equipment / technology to the patient for transmission of measurement readings and alerts/notifications via electronic means for review. Physiologic measurements could include weight, blood pressure, blood oxygen levels, etc. Not reported if less than 16 days of readings. Can be reported once each 30 days.


CPT: 99457

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes


Reimbursement (national): Facility $32.84; Non Facility $51.61


Monitoring, evaluation and review of data, treatment adjustments, interventions, and other treatment management services provided by physician / staff / other qualified healthcare professional for patient. This code represents the first 20 minutes of clinical staff/physician/other qualified health care professional’s time per calendar month. Requires some point of “interactive communication” with the patient or caregiver, such as a phone call.


CPT: 99458

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes (List separately in addition to code for primary procedure)


Reimbursement (national): Facility $32.84; Non Facility $42.22


This treatment management code is billable for an additional 20 minutes of RPM services during the calendar month.


Why should you implement a remote patient monitoring strategy?

There are many benefits to remote patient monitoring, but we’ve listed a few below;


  • Improved quality of care

  • Ability to provide ongoing care, reducing gaps in care

  • Better health outcomes

  • Support and disease management education

  • Increased patient satisfaction and better patient experience

  • Promote patient loyalty

  • Enhanced data insights of health status between in person visits

  • Better care coordination

  • New revenue streams


Does outsourcing RPM components make sense for you?

Outsourcing staff to complete components of RPM can promote faster adoption and enable scalability, with limited impact to current workflows. Contracted staff act as an extension of an organization’s team – and provide support, education and feedback to patients. Organizations available for 3rd party outsourcing can also help with patient enrollment, documentation requirements, and ensure billing is captured for rendered services. Outsourcing can enable more patients to receive the benefits of remote monitoring, and could be a good option for organizations to consider. Outsourcing can be done when there is a direct contractual relationship between the billing provider and staff providing services.


Resources

2020 Physician Fee Schedule Final Rule –

https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

2019 Physician Fee Schedule Final Rule –

https://www.gpo.gov/fdsys/pkg/FR-2018-11-23/pdf/2018-24170.pdf

Center for Connected Health Policy Telehealth Billing Guide for Providers–

https://www.cchpca.org/sites/default/files/2020-01/Billing%20Guide%20for%20Telehealth%20Encounters_FINAL.pdf



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