What are The Essential RPM CPT Codes?

Remote Patient Monitoring (RPM) enables the doctors to monitor the health status of their patients using certain devices and the patients remain at home. For billing these services there are unique codes known as CPT codes. 99453 is used for initiating the devices and educating the patient on how to use them. 

The Question is: what are the essential rpm CPT codes? Here are a few of them; 99454 is for providing the devices and collecting data for 30 days. 99457 is used for the initial 20 minutes spent analyzing data and discussing the patient’s health. If more time is needed, 99458 adds extra 20-minute blocks. 

These codes help doctors to be paid for monitoring the health of their patients from a distance. Thanks to them, stable patients who suffer from chronic disease or those in the process of recovering, would not have to visit the clinic so often.

What is RPM?

Remote patient monitoring is an important branch, a strong addition, and a vast expansion of telemedicine, which has brought many benefits to the health sector.

The part played by RPM in reducing the risks associated with COVID-19 has undoubtedly been significant and that is why it has become a valuable replacement for physical examination. Remote patient monitoring has now become quite popular and enables medical personnel. Similarly, you can contact us for availing of the medical coding services with accurate CPT codes at Prospect Healthcare Solutions. 

What are RPM CPT Codes?

 Particularly, specific RPM CPT codes are employed to incentivize clinicians and facilitate remote patient monitoring. The following are rpm billing codes; CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 9909. But what are these codes and how do they operate? Let’s get right into it.

1. 99457 Code Description

CPT Code 99453 was created to be a way to help patients who are not capable of using their mobile phones or have a hard time operating medical equipment. This service code helps them to get an education on how to use these devices and in turn, reimburses the medical health providers for providing these services to the patients.

Equally, it includes time for education or training of the patient because as mentioned earlier the CMS does not compensate for the pieces of equipment. The service code for the enrolment for RPM is also refundable under this code. 

2. CPT Code 99454

CPT Code 99454 is billed once the RPM enrolment process of a patient is done, and the monthly services are initiated. These services are reportable under CPT Code 99454 as they cover alert transmissions and reporting of the administration of healthcare devices for health-related data. CPT Code 99454 is highly valued for the programming and supply of health-related devices. 

3. CPT Code 99091

While CPT Code 99091 is still current with CMS, the codes enumerated earlier describe the different medical conditions that warrant billing more appropriately. It involves information gathered within 30 days and cannot be billed in the same month as CPT codes 99457 and 99458.

Prospect Healthcare Solutions provides a unique telemedicine solution for enhancing RMP to improve patient adherence and thus increase practice size and contribute greatly to practice income. 

4. 99453 CPT Code Description

As it has been mentioned above, CPT Code 99453 was created as a way to help a patient who cannot work their mobile phones, have a problem with the operation of medical equipment, or is not tech-savvy at all. This service code helps them to receive an education on how to operate these devices and in turn, reimburses the medical health providers to provide these services to the patients.

Additionally, encompasses the time spent educating or training the patients because the CMS does not compensate for the parts and accessories. The procedure code for the enrolment for RPM is also reimbursable under this code. 

5. CPT Code 99091

Even though the code 99091 has not been deleted for now as per the CMS, the codes mentioned earlier give a better understanding of the different medical conditions for billing. It covers data obtained in 30 days and cannot be billed in the same month as CPT Codes 99457 and 99458.

What are the Essential RPM CPT Codes-Maximize Your RPM Revenue 

As a result, Prospect Healthcare Solutions can be considered one of the market leaders for remote patient monitoring and coding. Our comprehensive RPM services offer healthcare providers two things:

• Improved patient outcomes. Chronic disease patients can easily have their health worsen within a short time. Our nurses are used as an early warning system because they go through the vitals and alert the physicians when these changes are likely to happen.
• Higher profits. Currently, CMS pays RPM about $120 per person per month. While having 50 RPM patients it comes to $72000 a year lost revenue.  

CPT Codes for Remote Patient Monitoring

The codes are 99453 for the first RPM encounter and education 99454, for the subsequent monthly device supply and transmission of data, and 99457 for the first 20 minutes of clinical staff time for RPM services. However, if a provider goes beyond the 20 minutes, he or she is entitled to use code 99458 for each additional 20 minutes spent.

Furthermore, these RPM services are allowable by a physician or a qualified healthcare provider. The 99091 code can also be used for the collection and interpretation of physiologic data if it takes at least 30 minutes of a professional’s time each month. These codes assist the healthcare providers to monitor and cost the expanding area of remote monitoring services.

Bottom Line 

What are the essential RPM CPT codes? So, basic RPM CPT codes are important for a healthcare provider to get adequate payment for remote monitoring services. These codes 99453, 99454, 99457, and 99458 allow practices to make money while ensuring that patients in their homes receive excellent care. 

Similarly, due to improper CPT code application, there is a high possibility of having the claims rejected. Therefore, loss-making on their remote monitoring services. Combined with the designation of appropriate RPM CPT codes, this information also assists in monitoring utilization progress and the efficacy of remote monitoring programs throughout various networks.  For more information about the CPT Codes and smooth billing, reach out to us at Prospect HealthCare Solutions. 

FAQ’s

What are the CPT codes for RPM?

The primary CPT codes for Remote Patient Monitoring (RPM) are:

• 99453: Explanation of RPM devices and instructions given to the patients.  
• 99454: Supply of devices monthly and transmission of data.  
• 99457: The first 20 minutes of RPM treatment management.  
• 99458: More than 20 minutes in terms of management of RPM treatment.  
• 99091: Collection of Organism physiological data.

What is CPT code 99453 for RPM?

The code 99453 when reported, covers the initial consultation and counseling of a patient for RPM. This is charged once per episode of care and does not include the cost of the device. E/M applies only to those services that include electronically transferring and collecting patient information.

What are CPT codes 99457 and 99454?

• 99457: Applies to the first 20 minutes per calendar month for clinical staff, physicians, or qualified healthcare professionals for the management of interactive remote patient monitoring or communication with the patient.  
• 99454: Concerns the monthly requirement of remote monitoring pieces of equipment and disc transmission of captured physiological parameters.   

What is CPT code 99091 for RPM?

Code 99091 is used when the patient collects physiological data electronically and transmits it to the provider. At least 30 minutes of provider time is spent per calendar month on this care plan. This code entails, therefore, being practiced by the physician or a qualified healthcare personnel.