Written by: Maliha Safiullah

Maliha Safiullah is a Former Correspondent for 60 Minutes, Channel Nine Australia and is a published writer having worked as a Feature Writer for Dawn News.

Remote Patient Monitoring (RPM) is a growing trend in the healthcare industry and with AI powered systems, it is revolutionizing the methods through which quality care is provided to people. RPM involves high-end technology that utilizes health sensors attached to the body through a device-agnostic system that collects, analyzes and transfers patient data to a corresponding healthcare facility. With the introduction of Telemedicine CPT Codes 2020, Centers for Medicare and Medicaid Services (CMS) have enabled RPM to provide solutions more feasibly.

RPMs have provided a multitude of benefits and considering the current COVID-19 situation, have become an absolute necessity for patients who require chronic disease management, post-discharge care or are older adults confined to home either due to old age or limitation in mobility. By establishing a connection with such patients, RPM systems have created a simple method for healthcare organizations to be constantly aware, in real-time, about high-risk patients by maintaining a track of data in between visits.

The RPM CPT Codes issued by CMS in the 2019 Physician Fee Schedule were aided by an addition of another code in earlier 2020 that permitted charging for an added 20 minutes of clinical time.  The finalization and issuance of these Telemedicine CPT Codes 2020 validates CMS’ support and credence in RPMs and sets out to ensure improved return on investment for providers. Patient monitoring when done remotely has the capacity to provide quality care to patients while warranting patient outcomes at a reduced cost. These new rules and RPMs’ potential may encourage providers to endorse and invest in RPM systems and benefit both hospitals and patients.

RPM CPT Billing Codes

CPT code 99091:

Collection and interpretation of physiologic data digitally stored and/or transmitted.

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, 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:

Reported in conjunction with 99457 to report each additional 20 minutes of time.

How Do Remote Patient Monitoring Billing Codes Work?

Providers are required to comprehensively understand the billing for remote patient monitoring and how to utilize them separately or/and in combination to be able to derive the maximum benefit out of RPM technology. The relevant utilization of the codes can deliver a solution to providers for monitoring, engaging and assisting chronic patients or older adults proficiently while getting reimbursed. RPM may benefit physicians as they will be in a position to extend their services in terms of time, quality and population while also increasing their profitability.

For deployment of the codes for a smooth billing for remote patient monitoring, it is also essential to completely comprehend the various requirements that they entail:

  • Firstly, the use of an RPM service needs to be instructed by a certified healthcare professional followed by patient consent since the patient must opt for the service.
  • Thirdly, the devices employed must be categorized and comply with the definition of a ‘medical device’ as termed by the FDA.
  • Fourthly, the data collected on the mentioned device must be wirelessly synced for assessment and the data monitoring should be handled by a qualified physician, healthcare professional or clinical staff.
  • Lastly, the monitoring of the patient must extend to more than 16 days to qualify as a billing period.

How RPM CPT Codes 2020 Benefit Physicians & Providers:

Read more on How has remote patient monitoring for healthcare been beneficial?

The CMS’ 2019 rule specified that when employing RPM services, assisting healthcare personnel had to be under the direct supervision of a physician which meant that a physician had to be physically present at all times when the supporting staff delivered or managed the RPM service. CMS altered the rule in 2020, permitting the physician to not be present in the same building and allowing the supporting staff to be under general supervision. This alteration in the rule has provided an opportunity to RPM providers to generate programs that are both convenient and flexible to patients being monitored remotely. The extra 20 minutes of time also meaningfully raises the prospective revenue for providers, making it financially feasible.

For providers who use RPM services to manage patients outside a medical facility, it becomes lucrative to appropriately utilize resources in ways that benefits themselves, patients and physicians. RPM data insights give physicians the opportunity to provide timely intervention to patients who require it, which in turn saves not only lives but frequent readmissions and costs. For the medical health staff this is beneficial since it optimizes the physicians’ and the nursing staffs’ time and extends the hospital resources for patients who require them the most. With an RPM in place, hospital capacities can be extended and medical health staff can find themselves in a better position to administer the best possible care for patients who need it the most.

Furthermore, the CMS rules for administering RPM also safeguards patients from being exposed to and acquiring hospital infections. A patient who is monitored in the comfort of his/her home receives quality care while avoiding continual hospital visits and hence is safe from hospital-acquired infections. Providers are in a better position to administer quality healthcare when they have real-time data and better understanding of a patient’s overall health that is provided by the RPM solution. Data accumulation and AI-powered algorithms, deliver information to providers that may help them in generating treatment plans for patients that suits them best individually.

There are various medical and financial benefits of RPM with the implementation of the new CPT codes as they not only give providers a chance to collect significant patient data but also utilize resources in the best possible ways that benefits all the components of the industry. With the correct strategy in place, investment and utilization of an RPM system can result in augmenting of the ROI on their RPM investment while also profiting their staff and providing better care services to their patients.