Cellular Reimbursable Remote Patient Monitoring (RPM)

What Is Reimbursable RPM?

Reimbursable Remote Patient Monitoring (RPM) refers to reimbursement for connected diabetes care services that enable clinicians to manage and coordinate patient care outside of a healthcare setting with reliable, actionable data.

The Centers for Medicare and Medicaid Services (CMS) have recognized the value of RPM by offering four CPT reimbursement codes. Health plans (i.e. UnitedHealthcare, BCBS, Cigna) have adopted the same reimbursement codes and guidelines.

CPT 99453

Product
Training

$18.48* One-Time

Remote monitoring of physiologic parameter(s) (e.g. blood glucose levels), initial; set-up and patient education on use of equipment.

CPT 99454

Data
Transmission

$54.10* Monthly

Remote monitoring of physiologic parameter(s) (e.g. blood glucose levels), initial; device supply with daily recording or programmed alert transmission, each 30 days.

CPT 99457

Patient
Management

$48.72* Monthly

Remote physiologic monitoring, 20 minutes or more of healthcare professional time monthly requiring communication with the patient/caregiver.

CPT 99458

Patient Management Extension

$39.65* Monthly

Amplifier for additional remote physiologic monitoring, 20 minutes or more of healthcare professional time monthly requiring communication with the patient/caregiver.

Improve Outcomes and Increase Revenues with Reimbursable RPM

RPM enables connected care where clinicians can monitor their patients between visits. With this continuity of care and the ability to review complete, real-time results, clinicians can intervene and flag situations before they become issues.

Reimbursable RPM can open up a new revenue stream that can also help clinicians grow their practice.

When clinicians follow the CMS guidelines, they could be reimbursed **$1,728* per patient, per year.**

Learn more about the CMS guidelines for reimbursement.

Cellular Technology Simplifies Remote Patient Monitoring

The real-time connectivity of cellular-connected monitors makes remote monitoring simple, reliable, and convenient for both healthcare clinicians and their patients.

Non-Cellular Solutions Create Barriers

Data sharing is complicated for patients, reducing engagement

Data delivery is unreliable, delayed and incomplete due to dropped connectivity

RPM is difficult and ineffective for clinicians and RPM companies due to a lack of quality, real-time data

Cellular Delivers a Dependable Information Stream

Perfectly simple for the patient

Game-changing, real-time cellular connectivity

Transformative for providers and partners

Cellular meters and programs, like those from Smart Meter, are making RPM easier for patients and clinicians alike.

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Implementing a Cellular Reimbursable RPM Program

Cellular technology simplifies the setup and usage of RPM for both clinicians and their patients.

Simple and Quick Training

CPT 99453

Leverage quick patient adoption with no technology to teach
Capture patient data in less than 30 minutes

Real-Time Data Transmission

CPT 99454

Gain immediate visibility to patient testing results
Enable patient messaging if desired

Impactful Patient Management

CPT 99457
CPT 99458

Analyze actionable data to manage patients remotely
Focus on exceptions requiring attention

Reimbursable RPM Resources

Below are articles to help you better understand RPM programs, solutions, reimbursement, and success stories:

Overview of states with remote patient monitoring reimbursement States that offer Medicaid and Medicare reimbursement for remote patient monitoring

mHealthIntelligence: CMS to Reimburse Providers for Remote Patient Monitoring Services Healthcare Finance: Getting Paid for Remote and Virtual Care Services: CPT Codes to Know and Understand

National Law Review: Medicare Remote Patient Monitoring Reimbursement FAQs: Everything You Need to Know About Chronic Care Remote Physiologic Monitoring Codes RPMBilling: Successful Clinic Operations for “Incident To” Billing

Frequently Asked Questions

Want to learn more? Below are some helpful FAQs that provide additional information on Remote Patient Monitoring.

What type of technology is best for RPM?

Blood glucose meters that use cellular technology are uniquely suited to support Remote Patient Monitoring. Unlike Bluetooth technology, cellular technology makes remote monitoring simple, reliable and convenient for both healthcare providers and patients. With cellular technology, BG results are automatically shared – in real-time – with clinicians, who can monitor patients for follow-up care on an ongoing basis.

Can CPT codes 99457 and 99458 be furnished by auxiliary personnel, incident to the billing practitioner's professional services?

CPT codes 99457 and 99458 may be furnished by auxiliary personnel, incident to the billing practitioner's professional services. Source

Is there an initial visit required to qualify for RPM?

For new patients or patients not seen by the practitioner within one year prior to billing RPM, the practitioner must first conduct a face-to-face visit with the patient (e.g., an annual wellness visit or physical). Source

Can a provider bill Remote Patient Management (CPT 99457 and 99458) and Chronic Care Management (CPT 99490) in the same month?

Yes, CMS recognizes RPM services are complementary to Chronic Care Management services. However, time spent furnishing these services cannot be double counted towards the required time for both RPM and CCM codes for a single month. Source

Is there reimbursement for training patients on iGlucose, iBloodPressure and iScale?

Yes. CPT 99453 offers separate reimbursement for the initial work associated with onboarding a new patient, setting up the equipment, and patient education on the use of the equipment. Source

Who can deliver RPM services?

CPT 99457 and 99458 allow RPM services to be performed by the physician, qualified healthcare professional, or clinical staff i.e. RNs and medical assistants
services. Source

Does a patient have be in a rural area for RPM reimbursement?

No. The patient does not need to be located in a rural area or any specific originating site. Source

Can the patient be at home to qualify for RPM reimbursement?

Yes, patients can receive RPM services in their homes. Source

Does RPM require a face-to-face exam or interactive audio-video?

RPM services do not require the use of interactive audio-video, as these codes are inherently non-face-to-face. Source

Is there a patient co-pay for RPM Services?

Yes, as a Medicare Part B service, the patient is responsible for a 20% co-payment for RPM services. Source

Do patients have to consent to receive RPM services?

Patient consent must be obtained and documented in the patients’ medical record. Source

How do the new RPM codes differ from the current CPT 99091?

The three biggest changes between from the new Chronic Care Remote Physiologic Monitoring codes and the current CPT 99091 are as follows:

33% Less time required. CPT 99091 requires at least 30 minutes per 30-day period, whereas CPT 99457 requires only 20 minutes per calendar month (33% less time than CPT 99091).

Separate payment for initial set-up and patient education. CPT 99091 does not offer additional reimbursement for the time spent setting up the RPM equipment or educating the patient on its use.

Clinical staff allowed. CPT 99091 is limited only to “physicians and qualified health care professionals” and does not expressly allow the RPM service to be delivered by clinical staff (e.g., RNs, medical assistants, etc.). This means the physician or qualified health care professional must personally perform (and document) the full 30 minutes per 30-day period

Source

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Reimbursable Remote Patient Monitoring Is Here

What Is Reimbursable RPM?

CPT 99453

Product Training

$18.48* One-Time

CPT 99454

Data Transmission

$54.10* Monthly

CPT 99457

Patient Management

$48.72* Monthly

CPT 99458

Patient Management Extension

$39.65* Monthly

Improve Outcomes and Increase Revenues with Reimbursable RPM

When clinicians follow the CMS guidelines, they could be reimbursed $1,728* per patient, per year.

Cellular Technology Simplifies Remote Patient Monitoring

Non-Cellular Solutions Create Barriers

Cellular Delivers a Dependable Information Stream

Implementing a Cellular Reimbursable RPM Program

Cellular technology simplifies the setup and usage of RPM for both clinicians and their patients.

Simple and Quick Training

CPT 99453

Real-Time Data Transmission

CPT 99454

Impactful Patient Management

CPT 99457CPT 99458

Reimbursable RPM Resources

Below are articles to help you better understand RPM programs, solutions, reimbursement, and success stories:

Frequently Asked Questions

Want to learn more? Below are some helpful FAQs that provide additional information on Remote Patient Monitoring.

What type of technology is best for RPM?

Can CPT codes 99457 and 99458 be furnished by auxiliary personnel, incident to the billing practitioner's professional services?

Is there an initial visit required to qualify for RPM?

Can a provider bill Remote Patient Management (CPT 99457 and 99458) and Chronic Care Management (CPT 99490) in the same month?

Is there reimbursement for training patients on iGlucose, iBloodPressure and iScale?

Who can deliver RPM services?

Does a patient have be in a rural area for RPM reimbursement?

Can the patient be at home to qualify for RPM reimbursement?

Does RPM require a face-to-face exam or interactive audio-video?

Is there a patient co-pay for RPM Services?

Do patients have to consent to receive RPM services?

How do the new RPM codes differ from the current CPT 99091?

Sponsored by Smart Meter, a provider of end-to-end solutions for reimbursable, real-time monitoring of chronic conditions.

Product
Training

Data
Transmission

Patient
Management

When clinicians follow the CMS guidelines, they could be reimbursed **$1,728* per patient, per year.**

CPT 99457
CPT 99458