The use of remote patient monitoring (RPM) is rapidly growing, both as a standalone solution and an essential part of other patient care models like population health management and hospital-at-home. At the same time, the rules have been shifting for how RPM can be billed, and when, and by whom. With that in mind, here’s an updated RPM billing guide to help healthcare organizations stay on top of this important information.

RPM billing guide: Understanding the basics

Before we can understand how billing for remote patient monitoring works, it’s important to define what RPM is, and how it’s used.

As a standalone program, remote patient monitoring refers to a system for the off-site management of patients with chronic conditions (and, since Covid-19, acute conditions, too). A combination of virtual telehealth technology and medical devices like remote BP monitors and pulse oximeters are used to collect and securely transmit physiologic data from the patient’s home to a healthcare provider’s EHR system, and then provide a basis for setting up a treatment plan and guiding the patient through it.

Need a primer? Read more about the difference between RPM and telehealth, and why it matters.

In delivering this care, it’s important to use RPM billing codes precisely and in a timely fashion. Doing so provides reimbursement opportunities as well as the chance to enhance patient care capabilities, and to bolster a clinical organization’s business viability with expanded capacity.

With that in mind, let’s take a closer look at each of the current billing codes behind remote patient monitoring.

How does billing for remote patient monitoring work?

Now that we understand RPM in its larger context, how does the specific billing for remote patient monitoring work?

First introduced by the Centers for Medicare & Medicaid Services (CMS) in 2018, the official CPT codes outline the who, what, where and why of RPM billing and reimbursement. As of 2022, these codes include 99091, a standalone code for remote patient monitoring, as well as 99453, 99454, 99457 and 99458, which work together as an RPM billing sequence:

  • CPT code 99091 is its own separate entity, “unbundled” from the codes below and usually ineligible for use in combination with any of them. It includes 30 minutes of clinical time between a patient and a physician or qualified healthcare provider (QHP) per month, and requires at least one instance of communication, which can be done remotely (i.e., a call, video visit or email exchange, but not text).
  • CPT code 99453 covers the initial time spent with the patient in program and/or device setup and education. It’s valid just once per episode of clinical care (the time from service activation to when treatment ends), even if the patient is cared for by more than one clinician, or uses a number of different RPM devices.
  • CPT code 99454 covers the time spent in remote monitoring of the patient on a monthly basis — specifically, the use of the medical devices used to remotely monitor and collect patient data. 99454 must be billed as a follow-up to 99453, and requires the transmission of data from a remote device for a minimum of 16 days within a 30-day period.
  • CPT code 99457 covers the initial treatment management of the patient. This includes reimbursement for the first 20 minutes of time spent with a patient per month. As with code 99091, these sessions can be conducted remotely, including a telephone or video connection — and, in some instances, text communication is allowed.
  • CPT code 99458 is an add-on to code 99457 — which means that it can only be billed as a follow up, and not as its own a standalone code. It covers additional time 20-minute periods of time spent in treatment management of the patient, with a maximum of 60 minutes total per month.

Although these codes can be expected to change in the years to come, the 2023 proposed rule includes no revisions specific to remote patient monitoring codes. You can read more about the 2023 proposed rule here.

Each of these codes is considered an evaluation and management (E/M) service, which typically can be billed by only physicians and other qualified healthcare professionals (QHPs) like nurse practitioners (NPs) and physician assistants (PAs). However, as of the CMS 2021 final rule (via Foley & Lardner LLP), other clinicians operating under the direct supervision of the primary doctor or QHP may also administer services for 99453, 99454, 99457 and 99458.

For the national average non-facility rate for each of these codes, as well as other details and stipulations, check out our 2022 guide to RPM codes. Remember, though, that specific reimbursement amounts will vary by several factors, including the city and state, as well as policies of private payers in a given region. To see policies in your area, check out the Center for Connected Health Policy (CCHP) website.

These codes can be expected to continue change on a year-to-year basis, as they have recently. You can read our latest update on the CMS’ proposed rule for 2023 here. And remember to check back with the CareSimple blog for updates, and for info on any new or updated codes.

Download our free Reimbursement Tree for a convenient, one-page summary of current CMS reimbursement codes.

RPM billing amid the ongoing public health emergency (PHE)

The above codes reflect measures taken to expand access to remote care during the Covid-19 pandemic. Because of the ability to remotely monitor critical information like body temperature, blood pressure and pulmonary function, RPM enabled providers to more safely keep tabs on patient health during the pandemic, without exposing themselves, their facilities or the patients themselves at undue risk.

For this same reason, RPM billing allowances were expanded during the public health emergency (PHE) to cover patients needing acute treatment, as well as chronic patients. In contrast to chronic conditions, which are lifelong, acute conditions are intense but short-lived — such as the result of a serious injury, or a dangerous virus like Covid-19.

The requirement for patient consent was also eased during the PHE, and is now permitted at the time of initial service instead of beforehand. The 16-day requirement was also shortened to two days, to better cover the treatment of more acute conditions. (However, this was done primarily for detecting and treating Covid-19, and not for the treatment of other conditions, and is not likely to be extended past the PHE.)

How is RPM billing different from billing for chronic care management (CCM)?

In addition to standalone programs, RPM is also used as the basis for other models of patient care, including:

For a full rundown of reimbursement codes for RPM, CCM and other adjacent models of care, download our handy CareSimple Reimbursement Tree.

Got questions on RPM billing? We’ve got you covered.

And if you’re seeking more info on billing for remote patient management, we’re standing by to help! Contact us today to get in touch with a CareSimple expert.