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Remote patient monitoring has become reimbursable in 2018 with its first dedicated CPT code 99091. Today, there are many more CPT codes dedicated to remote patient monitoring with several key CPT codes you should know about.
CPT 99091: remote patient monitoring, collection and interpretation of data
This code is intended to pay for time physicians and other qualified healthcare professionals spent on reviewing patients’ generated and electronically transmitted data such as blood pressure measurements taken by hyptertensive patients or blood sugar measurements taken by patients with diabetes. This code does not require any patient communication or feedback and cannot be billed by clinical staff not meeting the medical qualifications of a physician of HCP.
CPT code 99091 description: 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.
CPT code 99457: remote patient monitoring, with patient communication
CPT code 99457 pays for the initial 20 mins a physician, qualified healthcare professional or clinical staff member spends each month on patient care provided under a remote patient monitoring program where an interaction with the patient or the patient’s caregiver was part of those 20 minutes of care. CPT code 99457 was introduced in 2019 and initially reimbursed all remote patient monitoring time above 20 minutes each month. In 2020, the code has been revised and now includes the initial 20 minutes of care only, with a new CPT code 99458 reimbursing care time beyond those initial 20 minutes.
CPT code 99457 description: “Remote physiologic monitoring treatment management services, initial 20 minutes of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
CPT code 99458: remote patient monitoring, with patient communication, additional time
CPT code 99458 was introduced in 2020 when its sister code CPT 99457 underwent revision. CPT code 99458 reimburses 20 minute increments that are beyond the time reimbursable under CPT 99457. Simply said, in 2020 the CMS created additional financial benefit for practices with remote patient monitoring which, until 2020, were only able to bill for 20 minutes of care time provided to remotely monitored patients. CPT 99458 ensures that patients who require remote monitoring service beyond the initial 20 minutes qualify for another CPT code and hence their care provider is reimbursed for such care. By design, CPT code 99458 is only billable in addition to CPT code 99457 and never alone.
CPT code 99458 description: 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
CPT code 99453: monitoring device setup and education on its use
CPT code 99453 was introduced by CMS in 2019 as part of the new, remote patient monitoring dedicated bundle of codes. Acknowledging that remote patient monitoring programs depend on patients using health monitoring devices, CPT code 99453 was launched to reimburse medical practices that assist their RPM patients to use such a health monitoring device correctly. CPT code 99453 is applicable towards health tracking devices that are medically accurate and necessary, implying the need for an FDA approval or clearance and underlying patient health condition benefiting from RPM enrollment.
CPT code 99453 description: 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 patient monitoring with a device providing daily recordings or alerts
CPT code 99454 reimburses physicians, qualified healthcare professionals and clinical staff each 30 days for actively participating patients in a remote patient monitoring program using health tracking devices that are able to sync readings electronically back to their care provider. CPT code 99454 is specifically designed to pay for providing care based on the incoming patients’ vitals.
CPT code 99454 description: 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.
There are many more CPT codes available to medical practices offering remote patient monitoring. Reach out to our team to see what other CPT codes your practice might qualify for and how Lara Health platform can unlock new reimbursements for you.