Frequently Asked Questions About Remote Patient Monitoring

Technology is taking healthcare to the next level, and remote patient monitoring (RPM) is part of the wave. As it can improve health and make economic sense, increasing numbers of doctors and other healthcare professionals are providing RPM services. These FAQs on RPM can tell you what you should know about it.

Table of Contents

• What is RPM?
• How Can RPM Affect Patients, Providers, and the Healthcare System?
• Is RMP Covered in Medicare Advantage?
• Which CPT Codes Are Used for RPM Reimbursement?
• Why Did CMS Create New Codes for RPM?
• Who Can Provide RPM Services?
• What Technology Does RPM Use?
• Is RPM Reimbursement Only Possible When Patients Are in a Health Provider Shortage Area (HPSA) or a Rural Area?
• Is There a Requirement for Face-to-Face Visits or Interactive Video Chats for RPM Reimbursement?
• Do Patients Pay a Copay for RPM Services?
• Can Providers Also Bill for RPM When They Are Providing Chronic Care Management (CCM)?

What is RPM?

Remote patient monitoring (RPM) “uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.” [1]

Data may be collected in a variety of ways, such as via wearable devices, such as heart rate monitors and fitness trackers, wireless connected devices, such as blood pressure monitors and glucose meters, and apps, such as weight loss and diet logging apps. An example of RPM may be the collection of blood glucose measurements in a patient with diabetes, storage in an online database to which the provider has access, and analysis by the provider to assess the potential need for intervention or changes to the care plan.

How Can RPM Affect Patients, Providers, and the Healthcare System?

Patients, providers, and the healthcare system can potentially benefit from RPM. Patients may have better outcomes due to increased access to care as providers see richer data and provide feedback. Needed interventions can come sooner with RPM than with waiting for a traditional appointment, such as if a patient is experiencing higher blood pressure and a provider reaches out to make changes to prescriptions as part of RPM-related feedback.

Providers can benefit as their patients have improved health, since a shift to value-based care means providers can be more profitable as patients have better outcomes and avoid costly hospitalizations, emergency room visits, and other treatments related to poor control of a chronic condition or another preventable issue. In addition, RPM is reimbursable, allowing physicians to increase revenue streams.

Healthcare systems do better when patients are healthier. That is because healthier patients take up fewer hospital, clinic, and emergency room resources, including providers, staff, space, equipment, and money. Keeping patients out of hospitals became an even more urgent need during the COVID-19 pandemic, when the healthcare system was stretched to its limit. With RPM, patients can get a good amount of care without entering facilities.

Is RPM Covered in Medicare Advantage?

Yes, Medicare Advantage covers RPM. “You still get complete [Medicare] Part A and Part B coverage through…” Medicare Advantage. Medicare Parts A and B covers telehealth and RPM [2].

Which CPT Codes Are Used for RPM Reimbursement?

Using the following CPT codes, providers can potentially be reimbursed up to $150 per patient per month on an ongoing basis [3]. The CPT codes are 99453, 99454, 99457, and 99458.

• CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
• CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
• CPT code 99457: “Remote physiologic monitoring treatment management services, [initial] 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
• CPT code 99458: “Remote physiologic monitoring treatment management services, [additional] 20 minutes of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

Why Did CMS Create New Codes for RPM?

Before these new RPM codes, Medicare was already offering reimbursement for RPM services. The CPT code 99091 covered time spent collecting, analyzing, and providing feedback on patient-generated data. Billing was in minimum 30-minute increments and billed in a 30-day period, and only qualified providers could provide services.

The new codes were created because of the reality of technology and staffing, and how they affected RPM services. Compared to 99091, the new codes are a more accurate reflection of how these services are being provided. For example, billing is now in minimum 20-minute increments, and counted in calendar months rather than 30-day periods. In addition, clinical staff can also provide services, thus relieving physicians and other qualified providers.

Who Can Provide RPM Services?

The CPT codes for RPM services allow physicians and other qualified healthcare professionals and clinical staff, for example, registered nurses, to perform RPM. Practitioners must abide by state laws. The CPT handbook defines “qualified healthcare professionals.”

As of 2020, RPM can occur under general rather than direct supervision, which means providers can outsource monitoring and billing duties [4]. This can free up providers’ time when caring for patients with intensive management needs.

What Technology Does RPM Use?

A variety of technologies can be used in RPM. Examples of wearables include activity monitors, monitors that can provide information about a patient fall or patient location, and continuous glucose monitors (CGM) that are enabled to send the data to providers. Other devices for data collection during RPM can include wirelessly connected devices such as scales, blood glucose monitors, blood pressure monitors, and thermometers.

Data can be transmitted to providers via smartphone apps and online databases. To provide feedback to patients, email and patient portals are options.

Is RPM Reimbursement Only Possible When Patients Are in a Health Provider Shortage Area (HPSA) or a Rural Area?

While telehealth services previously needed to be rendered in HPSA or rural areas for Medicare reimbursement, RPM reimbursement does not require patients to be in these areas.

Is There a Requirement for Face-to-Face Visits or Interactive Video Chats for RPM Reimbursement?

The Centers for Medicare and Medicaid Services (CMS) did not specify that a face-to-face exam or interactive audio-video chat is necessary for reimbursement. The lack of specification for how interaction could occur allows providers, other qualified healthcare professionals, and clinicians to use technology such as online portals, emails, video chats, phone calls, and store-and-forward visits.

Patients who have not seen their practitioner within the prior year must have an in-person visit with their practitioner before RPM billing may occur. Physicals and annual exams, traditional care management services, and evaluation and management (E/M) services can count, since they have separate Medicare billing codes.

Do Patients Pay a Copay for RPM Services?

Yes. Patients who are in Medicare Part B pay a copay of 20%. Medicare Advantage patients have a copay that depends on their plan. 

Can Providers Also Bill for RPM When They Are Providing Chronic Care Management (CCM)?

Providers can bill for RPM and chronic care management, since these are recognized as distinct services. Chronic care management is billed under CPT code 99490 [5]. Time spent on CCM and RPM services must be separate. In a single month, billing for both RPM and CCM means the provider spends at least 40 minutes total, including at least 20 minutes each for RPM and CCM.