Medicare Remote Patient Monitoring Reimbursement FAQs: Everything You Need To Know About Chronic Care Remote Physiologic Monitoring Codes

Author:Mr Nathaniel Lacktman
Profession:Foley & Lardner

Remote Patient Monitoring (RPM) is the next big thing in medical care; patients just don't know it yet. And, it seems, neither do many physicians. On Thursday, CMS published the final rule on its new RPM codes, officially titled "Chronic Care Remote Physiologic Monitoring." There are three new RPM codes, all of which will go live starting January 1, 2019. These codes incentivize providers to effectively and efficiently use RPM technology to monitor and manage patient care needs.

Medicare Remote Patient Monitoring Frequently Asked Questions (FAQs)

  1. Does Medicare Already Cover Remote Patient Monitoring?

    Yes. Even before the new codes, Medicare already offered separate reimbursement for RPM services billed under CPT code 99091. That service is defined as the "collection and interpretation of physiologic data (e.g., 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." It went live for the first time on January 1, 2018.

  2. Why Did CMS Create the New RPM Codes?

    While industry advocates generally applauded CMS for activating CPT 99091, they recognized how that code fails to optimally describe how RPM services are furnished using current technology and staffing models. This failure may be due to the fact that CPT 99091 is 16 years old and had never before been a separately payable service. (It is an older code CMS "unbundled" and designated as a separately-payable service.) Indeed, the AMA's CPT Editorial Panel developed and finalized the three new RPM codes in late 2017. These are the codes CMS finalized effective in 2019. The new codes do a far better job in accurately reflecting contemporary RPM services.

  3. What Are the New RPM Codes?

    The new Chronic Care Remote Physiologic Monitoring codes are:

    CPT code 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." CPT code 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." CPT code 99457: "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." 4. How Much Time is Required...

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