2021 Medicare Remote Patient Monitoring (RPM) CPT Codes

A Brief Definition of Remote Patient Monitoring (RPM)

Remote patient monitoring, or RPM for short, means the use of physiologic readings data from a device to both monitor and manage a patient’s care remotely. There are many different types of devices that can be used, depending on the patient’s condition(s). Blood glucose monitors, blood pressure monitors, scales, pulse oximeters are the most common. However, for a device to qualify, it must be defined as a medical device under section 201(h) of the Food, Drug and Cosmetic Act. In addition, the data coming from the devices must be collected and transmitted electronically as opposed to self-reported by the patient.

Description of 2021 RPM CPT Codes & Reimbursement Rates

In 2018, CMS introduced CPT codes to reimburse providers for delivering RPM services to patients. The RPM reimbursement codes are similar to the Chronic Care Management (CCM) codes, but add device data collection and review to the requirements. Here is a breakdown of the RPM CPT codes and reimbursements currently available:

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
(Non-Facility Rate)
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
(Non-Facility Rate)
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.

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What Changes Did CMS Make in 2021 to Remote Patient Monitoring?

CMS continued to fine-tune the specifics in 2021. Below are a few of the more substantive changes to the RPM program and reimbursements from the 2021 Final Rule. However, you can review the details on all the changes in 2021 on this CMS fact sheet.

  • 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.

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