What are Remote Patient Monitoring CPT Codes in Medical Billing?

Since the COVID-19 pandemic, telehealth services are in high demand, which includes connecting patients online to deliver medical services. It helps connect patients via video calls, phone calls, and other online channels. Similarly, remote patient monitoring is a subset of telehealth services, which includes monitoring and assessing the health progress of patients through medical devices. To receive reimbursement for these services, converting them into compliant code is crucial. Hence, providers can outsource medical coding services to optimize overall collections.

What is Remote Patient Monitoring?

It is the medical care delivered by the provider that includes access to at-home medical devices and equipment. Likewise, it includes monitoring and managing patients’ chronic conditions through wearable devices. For example, a patient receiving medical care for heart disease may have a heart rate device to monitor their condition regularly. The provider analyzes the health chart sheet and provides care as per progress. In addition, the licensed healthcare professionals and qualified Non-Physician Practitioners (NPPs) are eligible for reimbursement after rendering RPM services. Billing these codes accurately is crucial for providers and qualified NPPs to improve RCM efficiency.

Remote Patient Monitoring CPT Codes

CPT Code 99453

It includes the initial setup and patient education on device use once per episode of care per device type. The provider educates the patient about the use and working of the medical equipment and devices essential for assessing the patient’s health. In addition, the billing of this code is made according to a one-time billing per 30 days per device type. For example, you have a patient with unstable blood pressure. You’ll educate and train them on how to use the BP monitoring device and bill this service under CPT Code 99453.

CPT Code 99454

It is a monthly service requiring 16+ days of data collection. The provider collects data on the patient’s health from the medical device allocated to the patient. It is not training on using the device, but collecting data from the device to monitor the health chart. For example, you have a patient with a high blood pressure issue. You’ll observe your patient’s monthly data to determine the times of irregular blood pressure. Hence, this collection of substantial data is reimbursed under the CPT Code 99454.

CPT Code 99457

It includes 20 minutes of live interactive RPM treatment management. The physician interacts with the patient virtually to assess the patient’s health with medical decision-making. Furthermore, the reimbursement is done for the first 20-minute monthly live interaction via video or audio call between the patient and the provider. For example, you provide virtual care to a hypertension patient with a Bluetooth-enabled BP device. On a monthly basis, you have a live interaction with your patient, and the first 20-minute interaction is reimbursed under the code 99457.

CPT Code 99458

It is an add-on code to 99457 (max 2x/month) for each additional 20 minutes. The provider spends an additional 20 minutes beyond the first 20-minute interval providing medical care. So, the provider files claims for additional RPM care management beyond 20 minutes to receive accurate reimbursement. It is billed when the virtual (audio or video) interaction between provider and patient exceeds 20 minutes.

CPT Code 99473

It is used to educate patients on using blood pressure monitoring at home. Reimbursement is done once per device or when the patient is given a new device to replace the old one. Furthermore, CPT Code 99473 is a reimbursement code for self-measured blood pressure (SMBP) monitoring. The provider ensures that the patient understands the technical aspects of the blood pressure (BP) device. It enables them to measure blood pressure accurately without assistance.

CPT Code 99474

It refers to the provider discussing the treatment plan with the patient after analyzing the blood pressure monthly report. The patient self-measures the blood, taking two readings at one time and one minute apart, but twice a day for a consecutive 30 days. The physician reviews the data on physiologic parameters to prepare a systolic and diastolic blood pressure report to discuss further treatment plans. Thus, the reimbursement for interpretation and changes in the treatment plan is claimed under the remote patient monitoring CPT Code 99474.

CPT Code 99091

It includes interpreting medical data from ECGs, blood pressure records, and home glucose monitoring results. A provider should give at least 30 minutes to render this service. Furthermore, this code must be used once after 30 days. You will not receive reimbursement for using CPT code 99091 more than once within one month. It is a stand-alone code that doesn’t need the support of CPT Codes 99453 and 99454 on a bill. In addition, it doesn’t require interactive communication between the provider and the patient.

CPT Code 95249

It is used for the service in which the physician measures the interstitial glucose levels at regular intervals via subcutaneously implanted sensors. The minimum measurement duration for this remote patient monitoring code is 72 hours. In addition, CPT Code 95249 is used for personal CGM systems in which physicians provide initial setup and patient training. It is billed for the duration during which the patient owns the CGM equipment for data collection, but it doesn’t include the removal of the sensor.

CPT Code 95250

Like CPT 95249, it is also used to bill services for measuring the interstitial glucose levels at regular intervals via subcutaneously implanted sensors. The measurement duration remains the same, at 72 hours. CPT Code 95250 differs from CPT Code 95249 because the CGM equipment, which measures glucose levels, is provided by the physician. The patient doesn’t own the equipment, and the removal of the sensor services is also billed under this code 95250.

CPT Code 95251

Remote patient monitoring CPT Code 95251 is used to bill for services involving the interpretation and analysis of continuous glucose monitoring data. The provider assesses the data from the medical device to change the treatment accordingly. Furthermore, the provider receives reimbursement once per month per patient for this code. The physicians, nurse practitioners, provider assistants, and clinical nurse specialists can file a claim for this service.

Conclusion

To sum up, remote patient monitoring services are delivered in a remote setting via audio or video calls. Provider educates patients on using medical equipment to promote patient engagement. Healthcare physicians can easily collect data from medical devices and examine the progress to make changes in the treatment. Furthermore, these services require accurate compliance to be converted into codes for efficient reimbursement. Hence, billing staff and providers submit clean claims with accurate codes and information to achieve consistent cash flow.

Frequently Asked Questions

What is remote patient monitoring?

Remote patient monitoring is a telehealth service during which the provider renders medical services remotely. It includes educating patients on the use of medical devices and interpreting the health data collected via devices to provide treatment accordingly.

How is remote patient monitoring important?

RPM provides access to at-home care with tools that help patients monitor their health on a regular basis. Furthermore, providers can welcome a variety of patients remotely, ultimately resulting in improved cash flow.

Which devices are eligible for RPM services?

FDA-approved physiologic monitors: blood pressure cuff, pulse oximeter, ECG devices, glucometer, thermometer, weighing scale, and spirometer.