Potential Revenue from RPM Programs

1. Patients

Number of Patients per Physician annually: (5000 Latest Industry Average as per Physicianleaders.org):

2. Physicians

Number of Physicians:

3. % of Medicare Patients at Office

Number of Medicare Eligible Patients (annually):

Number of Medicare Patients

An estimated number of Medicare Patients (annually):

4. % of Chronic Eligible Patients

% of Medicare Patients with 2 or more Chronic Conditions (annually):

Number of Chronic Eligible Patients

% of Medicare Patients Eligible for RPM (annually):

5. % of Patients Selecting RPM Program

Expected Number of Patients expected to opt for RPM (as a % annually):

Number of Opt-In Patients to RPM Program

Estimated Number of Patients You Expect to Opt-In (annually):

CPT Codes for Remote Patient Monitoring (RPM)

CPT 99453 - One time Setup at $21

Set-up, patient instructions and education regarding the use of RPM equipment: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate).

CPT 99454 - Apparatus and monitoring at $69/month

Device(s) supply with daily recording or programmed-alert transmissions: 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 99457 - Interventions at $54/month

Remote monitoring treatment/interactive services: Remote physiologic monitoring treatment management services that require 20 minutes or more of live (non-face-to-face), interactive communication (e.g. monitoring, etc.) between the patient/caregiver and the clinical staff/ physician/other qualified healthcare professional’s time in a calendar month.

CPT 99458 - Interventions at $43/month

Reported in conjunction with 99457 to report each additional 20 minutes of time: Remote physiologic monitoring treatment management services that require 20 minutes or more of live (non-face-to-face), interactive communication (e.g. monitoring etc.) between the patient/caregiver and the clinical staff/physician/other qualified healthcare professional’s time in a calendar month.

CPT Codes for Chronic Care Management (CCM)

CPT 99490 Standard CCM ($42/month)

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: ● Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient ● Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline ● Comprehensive care plan established, implemented, revised, or monitored

CPT 99487 Complex CCM ($93/month)

For complex CCM that requires substantial revision of a care plan, moderate or high complexity medical decision making, and 60 minutes of clinical staff time. 60 Minutes - $93 average reimbursement

CPT Code 99489 Complex + 30 ($47 /month)

Complex CCM add-on code for each additional 30 minutes of clinical staff time.

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Total Yearly Revenue based on RPM or CCM or Both

Check or Uncheck RPM CPT codes and CCM codes to see how this adjusts. (Time requirements 20 minutes RPM and 20 Minutes CCM)

Gross Revenue Minus 20% Co-Pay Collection Per Year

Gross Revenue Minus 20% Co-Pay. Per Year, excluding one-time setup code 99453. CMS states an office must attempt to collect a 20% co-pay per month per patient for RPM services.