Each year, the CMS makes adjustments to the Physician’s Fee Schedule that determines how healthcare providers are paid for the care of Medicare patients during the year. Since the introduction of the dedicated remote patient monitoring CPT codes in 2019, each year the CMS made changes and, lucily, always for the better. 2021 is no exception, further boosting the benefits of remote patient care for millions of Medicare beneficiaries as well as the medical practice that care for them.

If you are offering remote patient monitoring to your patients or are considering to start doing so, here are the main 2021 edits you should know about.

  1. CPT codes 99453 and 99454 requirements can be met by an oscillatory team

The CMS clarifies that activities that unlock CPT codes 99453 and 99454 don’t have to be performed by the clinic team or the doctor. CTP 99453 is a code that reimburses for the patient monitoring device set up and/or the patient’s education on the correct use of the device. This means that the monitoring device management can be done by a receptionist of an office administrator. The CPT 99454 code pays for the remote patient monitoring of the patient’s vitals. This would suggest that a non-clinical staff could potentially do the day-to-day patient management, perhaps in a clerical capacity such as running reports on patient measurement compliance or alerting clinical staff about out of range measurements.

  1. CPT code 99454 requires 16 days of measurements

The description of the CPT code 99454 caused a lot of confusion when it was first released in 2019. This year, the CMS clarified that this CPT code can only be submitted for patients who reported measurements on 16 days of the 30 period.

  1. Patients must use medical grade devices to monitor their vitals

It has been confirmed that practitioners are only allowed to claim for patients who are using medical grade devices to track their vitals. This means that step counters, Apple Watch or other “wellness” devices and tools do not qualify as medical devices under the remote patient monitoring rules. The common medical devices include blood pressure monitors, glucose meters and pulse oximeters.

  1. Remote patient monitoring devices must be able to transmit the patient vitals electronically

To qualify for the RPM reimbursements, the patients must use special remote patient monitoring devices that transmit the patients’ measurement automatically and in real time. This means that patients need to use devices that are either equipped with an internal transmitter or connect via Bluetooth to an app that can then pass the measurement to its destination automatically. This means that measurements entered by the patient manually, to an app or otherwise, do not satisfy the CPT code requirement. 

  1. CPT 99457/8 requires “some” communication but not all 20 minutes need to be a patient call

Many practices wondered about the 20 minute care time that requires a patient or patient caregiver communication. The CMS clarified that, although some communication must be part of the 20 minute timeframe, it doesn’t have to be all 20 minutes. Practices can continue counting other no face-to-face care related activities towards the 20 minute requirement, such as the time they spend on reviewing patient’s vitals or making adjustments to the patient’s medication schedule.

  1. The CPT 99454 requirements relaxed during COVID-19 for affected patients

The 16 days of measurements requirement has been relaxed for the duration of the COVID-19 pandemic for patients suspected or infected by the virus. Those patients need to report at least 2 days of measurements to meet the CPT 99454 eligibility.

Remote patient monitoring is unlocking a lot of new potential revenue to practices with a RPM program. Lara Health has published a 2021 Guide to RPM and CCM reimbursements to simplify billing for these non face-to-face programs. If you would like to request a copy please contact us at billing@lara.health