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RPM Codes

Reimbursement guide for providers

What is RPM?

RPM is short for Remote Physiologic Monitoring and involves the use of innovative digital technologies like HRT’s FollowApp service to monitor and manage patient care. In January 2019 the Centers for Medicare & Medicaid Services (“CMS”) released several CPT codes to reimburse providers for the use of RPM in their practices. Effective January 1st, 2020, CMS has further expanded reimbursement coding for both RPM and Telehealth.

By extending the clinic into patients’ homes with FollowApp, providers can improve overall quality of care and patient outcomes while achieving time savings and other clinical efficiencies that benefit their practices as a whole.

The core RPM codes released in 2019 and 2020 – 99453, 99454, 99457, and 99458 – are designed for use together.

CPT code: 99453

Reimbursement for patient onboarding education on the use of remote monitoring devices (e.g. blood pressure, weight scale, incentive spirometer)

CPT code: 99457

Reimbursement for the first 20 minutes of evaluation and management of RPM data collected and time spent communicating with the patient or a caregiver.

CPT code: 99454

Reimbursement for the collection of remote physiologic data.

CPT code: 99458

Reimbursement for each additional 20 minutes of evaluation and management beyond the initial 20 covered by 99457.

Selecting patients & technologies for RPM

There are two notable requirements associated with what constitutes “RPM” from both clinical and technical perspectives:

1. There must be medical necessity

  • a diagnosis of a chronic condition that can be managed using RPM technologies, such as heart failure
  • acute patients recovering from surgical procedures like cardiac or orthopedic surgery
  • a patient experiencing symptoms of a possible underlying condition which a provider wishes to evaluate prior to making a diagnosis.

2. Collection of physiologic data must be provided via electronic methods

The technical requirements of RPM include the collection of physiologic data such as blood pressure, heart rate, heart rhythm, weight, etc., and that monitoring of the data be provided via electronic methods.

In other words, there is a hardware component required for RPM; it is not enough to simply engage a patient in a transitional care program that does not involve the remote collection and transmission of physiologic data.

Similarly, having a patient collect physiologic data in a spreadsheet and email it to the provider does not fulfill the technical requirement to satisfy the definition of RPM under these codes.

Using FollowApp to fulfill the requirements of other commonly used Telehealth CPT codes

There are numerous commonly used CPT codes for which providers may be able to submit reimbursement based on FollowApp features and functionality. Among others, these include:

  • 99473 and 99474 for self-measured blood pressure: separate self-measurements of two readings, one minute apart, twice daily over a 30-day period (minimum of 12 readings).
  • 93040 and 93041 for a rhythm ECG with 1-3 leads
  • G2010 for the remote evaluation of recorded photo and/or images submitted by a patient
  • G2012 for a 5-10 min. technology-based check-in by a qualified health care professional
  • G2058 for chronic care management services, each additional 20 minutes of clinical staff time per calendar month (to be listed in addition to code for primary procedure)
  • 96160 for the administration of a patient-focused health risk assessment instrument
  • 99487 and 99489 for long-term complex chronic care management with moderate or high complexity decision-making (no face-to-face visit required)
  • G2061, G2062, and G2063 for qualified nonphysician healthcare professional online assessment and management service for an established patient for up to 7-days
  • 99421, 99422, and 99423 for online digital evaluation and management service for an established patient for up to 7 days, cumulative time during the 7-days
  • 99495 and 99496 for transitional care management services, moderate or high complexity

CPT Code: 99453

Remote Monitoring of Physiologic Parameter, Set-up and Patient Education on Use of Equipment

Summary

99453 may reimburse providers for the time spent onboarding patients with FollowApp. HRT streamlines this workflow for both the patient and the provider to be completed in about 10 minutes, including account creation and practice readings.

While CMS does not specify steps to satisfy the requirements of 99453, HRT recommends that providers complete the FollowApp onboarding process described below before submitting a claim under 99453.

Clinical Requirements 1 The provider provides the patient with remote monitoring equipment to track and report parameters, such as weight, blood pressure, blood oxygen levels, and expiratory flow rate, and remotely monitors the recordings and programmed alerts via electronic methods. 
Frequency 1 One time only
At a minimum, HRT recommends completing the following elements of the FollowApp onboarding process before submitting for reimbursement under 99453. [ ] Issue patient a FollowApp kit.
[ ] Assist patient in activating their FollowApp account.
[ ] Guide patient through at least one practice reading with each device included in their kit.
[ ] Offer to answer any questions the patient may have.
1 2020 Medicare Physician Fee Schedule and Quality Payment Program, CMS Final Rule CPT Codes 99453, 99454, 99457, 99458

CPT Code: 99454

Remote Monitoring of Physiologic Parameters, device(s) supply with daily recording(s) or programmed alert(s) transmission

Summary

99454 may provide reimbursement for the remote collection and monitoring of physiologic data using electronic methods, like FollowApp, which extend the clinic to the home.

With FollowApp, physicians can select from existing RPM care pathways or quickly and easily customize new ones with nearly any connected device – blood pressure monitors, pulse oximeters, weight scales, mobile ECGs, HRT’s patented digital spirometry system, and more. FollowApp is designed to connect seamlessly with third-party API’s, enabling providers to integrate emerging digital technologies and services into their FollowApp care pathways.

As with 99453, CMS has opted to define the requirements for 99454 broadly. FollowApp’s holistic approach to patient engagement has achieved over 90% daily engagement with patients ranging from their 30s to their 80s – compliance figures that have consistently yielded clinically actionable data for remote management of patient care.

Clinical Requirements 1 The provider provides the patient with remote monitoring equipment to track and report parameters, such as weight, blood pressure, blood oxygen levels, and expiratory flow rate, and remotely monitors the recordings and programmed alerts via electronic methods. 
Frequency 1 Each 30 days
At a minimum, HRT recommends that providers should be able to answer “Yes” to the following questions regarding the collection of remote physiologic data and associated monitoring services before submitting for reimbursement under 99454. [ ] Have at least 16 days passed since the patient was onboarded with FollowApp?
[ ] Was the patient enrolled in FollowApp for at least 16 days in the current 30-day period?
[ ] Was remote monitoring of the collected physiologic data points conducted during the current 30-day period?
1 2020 Medicare Physician Fee Schedule and Quality Payment Program, CMS Final Rule CPT Codes 99453, 99454, 99457, 99458

CPT Code: 99457

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes.

Summary

99457 may be used to reimburse providers for 20 minutes of remote management of patients’ conditions using physiologic and other data collected via RPM platforms like FollowApp.

In addition to broad flexibility with the devices and services physicians can choose to integrate with their FollowApp care pathways, the FollowApp platform includes a variety of features designed to facilitate the remote management of patients’ conditions. This functionality includes the ability to furnish educational modules, develop surveys and other qualitative feedback tools, customize alert thresholds, and communicate directly with patients via secure audio and video links between the FollowApp clinical portal and patient mobile application. All patient-provider interactions are documented for the purposes of facilitating reporting of appropriate CPT codes and as supporting documentation in response to audited claims, as may be necessary.

As with 99453 and 99454, CMS has defined the requirements for 99457 broadly:

Clinical Requirements 1 The provider evaluates recordings from remote monitoring equipment to track and report physiologic parameters such as weight, blood pressure, blood oxygen levels, and expiratory flow rate. The provider communicates with the patient or caregiver to adjust the patient’s management based on the patient’s reports.
Frequency 1 Once per calendar month
At a minimum, HRT recommends that providers should be able to answer “Yes” to the following questions regarding the collection of remote physiologic data and associated monitoring services before submitting for reimbursement under 99457. [ ] Was at least one phone or video interaction with the patient completed during the current 30-day period?
[ ] Was remote physiologic data collected through FollowApp during the current 30-day period?
[ ] Did the provider spend at least 20 minutes evaluating the data, managing the patient’s condition, and interacting with the patient during the current 30-day period?
1 2020 Medicare Physician Fee Schedule and Quality Payment Program, CMS Final Rule CPT Codes 99453, 99454, 99457, 99458

CPT Code: 99458

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes.

Summary

99458 may be used to reimburse time spent remotely managing patients conditions beyond the initial 20 minutes covered by CPT 99457. Providers may submit 99458 for each additional 20 minutes of clinical time spent on E&M, as may occur from time-to-time with more complex patients and diagnoses.

As with the other RPM CPT codes detailed herein, all patient-provider interactions are documented by the FollowApp platform for the purposes of facilitating reporting of appropriate CPT codes, and as supporting documentation in response to audited claims, as may be necessary.

Clinical Requirements 1 The provider evaluates recordings from remote monitoring equipment to track and report physiologic parameters such as weight, blood pressure, blood oxygen levels, and expiratory flow rate. The provider communicates with the patient or caregiver to adjust the patient’s management based on the patient’s reports.
Frequency 1 Once per additional 20 minutes of clinical E&M time spent
At a minimum, HRT recommends that providers should be able to answer “Yes” to the following question regarding the collection of remote physiologic data and associated monitoring services before submitting for reimbursement under 99458. [ ] Did the provider spend at least 20 minutes beyond the initial 20 minutes reported for 99457 evaluating the data, managing the patient’s condition, and interacting with the patient during the current 30-day period? 
1 2020 Medicare Physician Fee Schedule and Quality Payment Program, CMS Final Rule CPT Codes 99453, 99454, 99457, 99458

Other commonly used Telehealth CPT codes

CPT Codes
Description

99473

99474

Self-measured blood pressure

  • Patient training and device calibration
  • Separate self measurements of two readings, one minute apart, twice daily over a 30-day period (minimum of 12 readings) with systolic and diastolic averages reported to a qualified healthcare professional and communication of a treatment plan to the patient.

93040

93041

Rhythm ECG, 1-3 leads:

  • with interpretation & report (93040)
  • tracing only (93041)
G2010 Remote evaluation of recorded photo or video submitted by patient
G2012 Brief (5-10 minute) technology-based check-in by a qualified healthcare
G2058 Chronic care management services, each additional 20 minutes of clinical staff time directed by a qualified health care professional, per calendar month. Use G2058 in conjunction with 99490.

G2061

G2062

G2063

Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days:

  • 5-10 minutes
  • 11-20 minutes
  • 21 or more minutes

96160 Administration of patient-focused risk assessment instrument with scoring and documentation

99421

99422

99423

Online digital evaluation and management service, for an established patient, for up to 7 days

  • 5-10 minutes
  • 11-20 minutes
  • 21 or more minutes

99487

99489

Complex chronic care management services for patients with 2 or more chronic conditions:

  • 60 minutes in a calendar month of clinical staff time spent managing a patient’s care under direction of a qualified health care professional, moderate or high complexity medical decision making (no face-to-face visit required) (99487)
  • Report 99489 for each additional 30 minutes per calendar month spent performing the services described for 99487.
99490 Chronic care management services, initial 20 minutes of clinical staff time spent implementing, establishing, revising, or monitoring the comprehensive care plan for a patient with two or more chronic conditions. This is mostly online.

99495

99496

Transitional Care Management Services requiring communication (direct contact, telephone, or electronic) with the patient and/or caregiver within 2 days of discharge:

  • Medical decision making of at least moderate complexity (99495
  • Medical decision making of high complexity AND a face-to-face visit within 7 days of discharge (99496)
Source: 2020 Medicare Physician Fee Schedule and Quality Payment Program, CMS Final Rule