A Brief Definition of Remote Patient Monitoring (RPM)
Description of 2021 RPM CPT Codes & Reimbursement Rates
|CPT Code||What it Covers||Who can bill||How Often||How Much Medicare Reimburses|
|99453||Initial Setup of Device||Not Specified; Not Required to be Clinical Staff (Practice Expense Only Code)||Billed 1X Per Patient, Only First Month of Reading for 99454||$19.46|
|99454||Device Supply With Daily Recordings and Programmed Alerts||Not Specified; Not Required to be Clinical Staff (Practice Expense Only Code)||Billed Each 30 Days, Minimum of 16 Days of Monitoring*||$64.15|
|99457||20 Minutes of Monitoring and Treatment Management That Includes Interactive Communication With the Patient or Caregiver During the Calendar Month||In Indirect General Supervision of Clinical Staff||Billed Each Calendar Month||$51.54
|99458||Each Additional 20 Minutes of Monitoring and Treatment Management Services Provided.||In Indirect General Supervision of Clinical Staff||Billed Each Calendar Month||$42.22
|99091||30 Minutes of Monitoring Each 30 Days That Does Not Require Interactive Communication||Performed by Physician, Other Qualified Healthcare Professional (QHCP) or Clinical Staff||Billed Each 30 Days||$58.38|
*During COVID-19 Pandemic, 2 Days Of Monitoring Is Required, But Only If Patient Has Suspected Or Confirmed COVID-19 Case.
(Note: Need to scale RPM, but don’t have the nursing capacity, expertise & tech? Pilot Signallamp at no out-of-pocket expense.)
What Changes Did CMS Make in 2021 to Remote Patient Monitoring?
- Clarification of the COVID-19 Two Measurement-Day Waiver – CMS clarified that this waiver only applies to patients that have either suspected and/or confirmed cased of COVID-19. For all other patients, the 16 measurement days would apply.
- Established Permanent Policy for Delivery of Services by Auxiliary Personnel – For CPT codes 99453 & 99454, CMS permanently approved that auxiliary personnel may provide services under indirect supervision of a physician. Auxiliary personnel is defined by CMS as “… any individual who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician.”
- Expanded Coverage to Acute Conditions – CMS clarified that RPM services may also be delivered to patients with acute conditions, in addition to those with chronic conditions.
- Clarified Definition of Interactive Communication – CMS clarified that at least some of the time spent with towards CPT Codes 99457 & 99458 must include care management services and real-time interactions.
- Data & Device Requirements – The final rule states that devices must meet the definition of a medical device as defined by the Food, Drug and Cosmetic Act, and that the data from those devices must be collected and transmitted electronically, i.e., no patient reported data is allowed.