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 adding three new CPT reimbursement codes. Health plans (i.e. UnitedHealthcare, BCBS, Cigna) agree and have adopted the same reimbursement codes and guidelines – with more soon to follow.

CPT 99453

Product
Training

$21* One-Time

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

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CPT 99454

Data
Transmission

$69* 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.

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CPT 99457

Patient
Management

$54* Monthly

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

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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 $1,497* per patient, per year.

Learn more about the CMS guidelines for reimbursement.

Leverage the Best Technology for Reimbursable RPM: Benefits of Cellular

The real-time connectivity of cellular blood glucose meters 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

Remote patient monitoring is difficult and ineffective for clinicians

Cellular Delivers a Dependable Information Stream

Data sharing is automatic with each measurement

Cellular data is 100% accurate, real-time and actionable

Clinicians can now make confident decisions

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

Learn More

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

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?

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  • 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.

CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner's professional services.

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  • CPT code 99457 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?

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  • 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 Chronic Care Management (CPT 99490) in the same month?

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  • 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?

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  • 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?

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  • CPT 99457 allows 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?

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  • 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?

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

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

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  • 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?

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  • 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?

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  • 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?

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  • 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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Sponsored by iGlucose, the leading cellular Remote Patient Monitoring solution for diabetes management.

Disclaimer: This information is intended for reference purposes only and does not constitute legal, medical or other professional advice. All decisions with respect to reimbursement are solely those of the medical provider and subject to applicable laws and regulations. No guarantee of reimbursement or eligibility for reimbursement is being made.

*CMS Reimbursement National Average; see CMS guidelines for state reimbursement rates

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