Introduction to RPM & Coding

The COVID-19 pandemic accelerated the adoption of remote patient monitoring (RPM), transforming it into a standard medical practice and standard health care procedure nearly overnight. This rapid shift has led Medicare, commercial payers and patients to embrace these non-face-to-face interactions, a change that might otherwise have taken years to materialize.

Remote monitoring allows health care providers to monitor patients outside traditional clinical settings, enhancing care continuity and patient engagement. The success of RPM relies on several factors including patient consent, understanding the applicable codes and coding properly for billing and integrating this service with other care management programs like chronic care management (CCM).

Key Codes and Consent for RPM Services

Patient Consent

Patient consent is necessary for RPM services, primarily because of the potential cost for the patient. Patients must understand that while they may not physically visit the clinic, the services they receive remotely are substantial and billable. Talking with patients and discussing the benefits (i.e., the time saved from coming in on an appointment and the value of the amount of quality data that will help shape their diabetes management care) is important so they understand what they are paying for with their copay.

Key Codes

One code central to RPM discussions and worth remembering is 99091. While this is not a specific diabetes management or device code, it covers the collection and interpretation of physiologic data, including glucose levels. 

Remember a few important factors when using 99091:

• CMS moved CPT code 99091 (related to remote patient monitoring) from bundled to a separate payment.
• Providers must obtain advance beneficiary consent for the service and document this consent in the patient’s medical record.
• For new patients or those not seen within one year before the provision of remote monitoring services, providers must initiate these services in a face-to-face visit, such as an annual wellness visit or physical.
• Providers can use 99091 no more than once in a 30-day period per patient.
• The code includes time spent accessing the data, reviewing or interpreting the data, and any necessary modifications to the care plan that result, including communication with the patient and/or her caregiver and any associated documentation.
• This code will not be subject to any of the restrictions on originating sites or technology that telehealth services are subject to by statute, allowing users of this technology more flexibility.

RPM billing codes also include 99453 (for patient setup and education), 99454 (monthly data transmission), 99457 and 99458 (for management and analysis services).

To bill these services, health care providers must ensure:

• A minimum of 16 days of data is collected monthly.
• Services provided align with the patient’s medical needs and are reasonable and necessary.
• The technology used for RPM is FDA-recognized.

It’s crucial to document all RPM activities thoroughly, ensuring they meet medical necessity and compliance requirements. Only one provider can bill for setup codes 99453 or 99454 in a 30-day period, and clarifications are still pending on whether multiple providers can bill for ongoing management codes 99457 or 99458 within the same period.

Patient Care

RPM represents a significant advancement in patient care, offering a proactive approach to managing chronic conditions and improving overall health outcomes. By understanding and using the correct RPM codes, obtaining necessary consents and implementing efficient tracking systems, health care providers can enhance their service delivery while ensuring appropriate reimbursement.

The adoption of RPM signifies a move towards more personalized, efficient and accessible health care, making it an invaluable component of modern medical practice.

In order for RPM to be successful, the practice must obtain patient consent, code properly for billing and integrate it as a service with other care management programs like chronic care management (CCM).

Recent Changes in Medicare Reimbursement
as of December 2023 

• Essential codes include 99091 for data collection and interpretation by qualified professionals, requiring at least 30 minutes per month. 

• Consent is necessary due to potential copay by patients. 

• CMS has specified that only established patients can receive RPM services as of 2024.