Updates to the billing and reimbursement of remote patient monitoring (RPM) have been in effect since January 1, 2022. As we briefly explained in a recent post here at the CareSimple blog, these new RPM codes from the Centers for Medicare & Medicaid Services (CMS) do represent some changes to reimbursement, albeit minor.
All the same, these new RPM codes for 2022 are worth a closer look, especially if you’re a provider who regularly bills for RPM services. And if you’ve been planning on transitioning to more remote care as Covid-19 continues to impact the nation’s care delivery system, it’s a great time to better understand the new RPM codes, their specific amounts, and how they can be used by you and your team.
New 2022 RPM Codes: The Basics
CPT® is short for “current procedural terminology,” the terminology used to categorize different healthcare services and tasks. CMS sets the amount of reimbursement for each CPT code, as well as the parameters of how often such a service or task can receive reimbursement within one calendar month, and which entity is allowed to receive those reimbursement dollars.
CPT codes to cover the remote collection of physiologic data (blood pressure, weight, etc.) have been in effect since 2018, when CMS implemented CPT code 99091 to promote the expanded use of telehealth services. And with the even greater need for remote services caused by the Covid-19 pandemic, the agency has expanded that reimbursement even further in the years since.
Now, with the 2022 physician fee schedule, they’ve walked that reimbursement back slightly, although not much. Experts believe the reason is to expand remote care to remote therapeutic monitoring (RTM) and chronic care management (CCM). By doing this, they would effectively expand remote care’s reimbursable services and eligible providers without necessarily changing the type of care delivered.
New 2022 RPM Codes: The Details on 99091, 99453, 99454, 99457 & 99458
With that bit of context behind us, let’s move on to a code-by-code breakdown. Please remember, though, that these prices are for non-facility national averages. Commercial reimbursement amounts for these codes may be different than what you see here. You may want to consult a local Medicare Administrative Contractor (MAC) to find out the exact reimbursement rates for your region.
CPT Code 99453
What is CPT code 99453 for?
CPT code 99453 covers the time spent for the initial setup. That includes the onboarding of a patient for RPM services by clinical staff — in other words, the initial explanation of how the device works, and setting up a treatment schedule.
Any other details?
99453 is valid just once per episode of clinical care (the time from service activation to when treatment ends). This is true even if the patient is cared for by more than one clinician, or uses a number of different RPM devices.
What’s the reimbursement amount?
CPT code 99453 allows for a one-time reimbursement of $19.03 (non-facility national average).
CPT Code 99454
What is CPT code 99454 for?
CPT code 99454 covers monthly remote monitoring of the patient. This includes the supply and use of the medical devices used to remotely monitor and collect patient-generated health data (PGHD). This specifically means data transmission, and does not include time spent educating and setting up the use of the device.
Any other details?
99454 must be billed in conjunction with 99453, and requires the transmission of data from a remote device for a minimum of 16 days within a 30-day period. However, there is an exception for Covid-19 patients during the ongoing public health emergency (PHE), in which only 2 days of monitoring are required.
What’s the reimbursement amount?
CPT code 99454 allows for a total reimbursement of $55.72 for 16 days, per person per month (non-facility national average).
CPT Code 99457
What is CPT code 99457 for?
CPT code 99457 covers the initial treatment management of the patient. This includes reimbursement for the first 20 minutes of time that clinical staff spends with a patient.
Any other details?
99457 is intended as a follow-up of the previous two codes. After setup, and after a certain amount of data is collected, CPT code 99457 covers the initial time spent by the physician or qualified clinician in actual treatment of the patient’s condition. Like the data collected, this can be also administered remotely, including a telephone or video connection.
What’s the reimbursement amount?
CPT code 99457 allows a reimbursement of $50.18, per person per month (non-facility national average), for 20 minutes of time with a patient.
CPT Code 99458
What is CPT code 99458 for?
CPT code 99458 covers additional treatment management of the patient. This includes reimbursement for the first 20 minutes of time that clinical staff spends with a patient.
Any other details?
99458 is used as a follow-up to the initial time covered by CPT code 99457, covering the additional time spent by the physician or qualified clinician in actual treatment of the patient’s condition. Like 99457, this treatment can also be conducted remotely.
What’s the reimbursement amount?
CPT code 99458 allows a reimbursement of $40.84, per person per month (non-facility national average), for each 20 minutes of time spend with a patient, with a maximum of 60 minutes total per month.
CPT Code 99091
What is CPT code 99091 for?
CPT code 99091 covers the standalone collection and interpretation of remote data. It includes 30 minutes of RPM clinical time between a patient and a physician per month, and also requires at least one instance of communication, which can be a call, video visit or even email exchange.
Any other details?
Because it was “unbundled” from other codes back in 2018, 99091 cannot be billed in conjunction with 99457, and is intended for stand-alone treatment. Also, unlike the other codes here, 99091 can only be billed by a physician or qualified health professional (QHP) — not general clinical staff. Also, unlike the 20 minutes required by 99457, CPT code 99091 requires 30 minutes of time spent.
What’s the reimbursement amount?
CPT code 99091 allows for a total reimbursement of $56.41 for 30 minutes of clinical time, per person per month (non-facility national average).
Got Questions on RPM Codes? We’ve Got You Covered
If you’re seeking more hands-on info on RPM reimbursement and related CPT codes, we invite you to download our free “Reimbursement Tree” guide, a convenient, one-page summary of the new CMS reimbursement codes.
And if you have any other questions about the use of RPM in your practice or organization, we’re standing by to help! Contact us here to get in touch with one of our experts or to schedule a demo today.