Implementing Chronic Care Management (CCM) and remote patient monitoring (RPM) is pivotal in effectively managing chronic diseases. According to the CDC, heart disease, cancer, and diabetes are the leading chronic diseases in the United States. Furthermore, they significantly contribute to the nation’s staggering annual healthcare expenses of $4.1 trillion.
This article explores the concepts of chronic care management and remote patient monitoring, highlighting their differences, benefits, and billing requirements associated with each. Additionally, it emphasizes the importance of integrating these two approaches to enhance patient care, promote early intervention, reduce healthcare costs, and improve health outcomes.
Understanding Chronic Care Management and Remote Patient Monitoring
Chronic care management refers to coordinating and providing healthcare services for individuals with chronic conditions over an extended period. For example, chronic diseases include diabetes, hypertension, heart disease, cancer, and asthma. Chronic diseases put the patient at significant health risk and a higher likelihood of mortality, acute exacerbation or decompensation, or functional decline. Therefore, chronic conditions require ongoing management and support to control symptoms, prevent complications, and improve overall well-being.
Exploring Remote Patient Monitoring
Remote patient monitoring (RPM) is a technology-enabled chronic care solution that allows healthcare providers to monitor patients’ acute or chronic health. It involves using wearables, sensors, and mobile applications to collect and transmit patient data to healthcare professionals for analysis and intervention.
The Differences Between Chronic Care Management and Remote Patient Monitoring
Chronic care management and remote patient monitoring are used in post-operative, acute, and chronic diseases. RPM collects vital health data, such as heart rate, temperature, weight, respiratory rate, blood pressure, etc. That vital health data is automatically transmitted to a clinician to assess the patient’s condition and provide a treatment plan and appropriate care.
On the other hand, chronic care management encompasses a broader range of strategies and techniques aimed at managing and treating individuals with 2 or more chronic medical conditions. CCM involves coordinating care beyond regular office visits and is specifically designed for individuals with multiple chronic conditions expected to persist for at least 12 months. It uses a comprehensive approach that includes various aspects, such as:
- Coordinating healthcare services.
- Developing personalized care plans.
- Facilitating communication between the patient and the healthcare team.
- Aims to enhance the overall quality of care for patients with chronic illnesses.
- Promotes well-being and minimizes the impact of conditions on their daily lives.
Remote patient monitoring is one component of the broader chronic care management framework. Integrating remote patient monitoring into chronic care management allows physicians to monitor patients between regularly scheduled in-office appointments.
Benefits of Chronic Care Management and Remote Patient Monitoring
Remote patient monitoring enhances care delivery when applied to chronic care management. Some of these benefits are provided below.
Early Intervention With CCM and RPM
Healthcare providers can identify potential issues early with remote patient monitoring, allowing timely intervention. For example, if a patient’s blood glucose levels consistently increase, healthcare providers can remotely adjust medication dosages or guide lifestyle modifications to prevent complications.
Reduced Healthcare Costs With CCM and RPM
By remotely monitoring patients, healthcare providers can reduce the need for frequent in-person visits, hospital readmissions, and emergency room visits. Early identification and intervention can help prevent the progression of chronic conditions and avoid costly complications. RPM is shown to be highly cost-effective for hypertension, offering potential long-term cost savings.
Lower Hospital Readmissions With CCM and RPM
Remote patient monitoring reduces readmissions and emergency department visits. Holistic virtual care plans are implemented to support patients at higher risk of readmissions. The care plan can be customized to generate risk alerts by utilizing remote patient monitoring, enabling healthcare professionals to respond promptly during emergencies. For example, in patients with chronic heart-related conditions, RPM has been shown to significantly reduce the likelihood of experiencing a cardiac-related emergency department visit.
Improved Patient Engagement With CCM and RPM
RPM empowers patients to actively participate in their care by giving them access to their health data and educational resources. Patients can monitor their progress, set goals, and make informed lifestyle choices. This engagement fosters a sense of ownership and encourages adherence to treatment plans.
Overall, remote patient monitoring complements chronic care management by maximizing patient care and promoting better health outcomes for individuals with chronic conditions.
Billing Chronic Care Management and Remote Patient Monitoring
The Centers for Medicare and Medicaid Services (CMS) acknowledges the vital role of Chronic Care Management as an essential primary care service that significantly enhances patient health and overall care. In addition, CMS recognizes that RPM can be valuable for delivering care to patients with chronic care conditions covered under CCM. Therefore, patients can be eligible for a remote monitoring program and chronic care management. While all CCM patients are eligible for RPM services, not all are eligible for CCM services.
CCM Billing
Therefore, to qualify for CCM, RPM patients must have 2+ high-risk chronic conditions expected to last at least 12 months or until the patient dies. However, the time allocated for providing care cannot be counted twice. It is not permissible to duplicate the time spent, and the time requirements for each code should be met independently. The following CPT codes are rounded national averages for CCM billing.
99437
Healthcare provider time for every additional 30 minutes, with no limit. The average national payment rate is $58.62.
99439
Clinical staff for every additional 20 minutes, with a limit of 2. The average national payment rate is $47.16.
99487
A minimum of 60 cumulative minutes is required during a 30-day period of non-in-person consultation time with establishing or monitoring a treatment plan, with no limit. The average national payment rate is $131.97.
99489
This code is billed along with CPT99487 for each additional 30 minutes of a non-in-person consultation, with no limit. The average national payment rate is $71.06.
99490
Clinical staff for the initial 20 minutes. The average national payment rate is $61.57.
99491
Healthcare provider time for the initial 30 minutes. The average national payment rate is $83.18.
For CCM, the base CPT code 99490 requires that the patient has at least two chronic conditions and receives CCM services for at least 20 minutes from clinical staff within a month. Billing of 99490 and 99491 in the same month is not allowed.
G0511
Special payment code for 20 minutes per month for rural health clinic (RHC) and federally qualified health center (FQHC), with no limit. The average national payment rate is $71.68.
RPM Billing
All Medicare beneficiaries can participate in remote patient monitoring; however, some requirements exist.
- A medical device must fit within the FDA’s definition of a medical device.
- The patient must opt-in for the service before ordering the device.
- The patient must use the device at least 16 days a month.
- Data collection must be HIPAA-compliant.
Remote patient monitoring billing is different from telehealth and CCM billing. The following section provides an overview of what the 5 RPM CPT codes cover in 2023, including the average reimbursement rate and requirements.
99453
This CPT code covers device set-up and patient education on equipment for vital sign monitoring, such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate, and weight. Furthermore, this one-time code is billed after the initial 16 days of monitoring in a 30-day period. The average national payment rate for CPT 99453 is $19.65.
99454
CPT 99454 pays for supplying the device for daily recording or programmed alert transmissions. Unlike the prior CPT 99453 code, CPT code 99454 may be used more than once, given that the patient uses the device for at least 16 days in one month in a 30-day period. The average national payment rate for this code is $46.50.
99457
Code 99457 is comprised of an initial 20 minutes of treatment management. An unspecified portion of that 20 minutes must involve interactive remote communication with the patient. There is no explicit explanation of how interactions must be provided. It is assumed that video, phone, email, and text messages all suffice. The average national payment rate for this code is $48.14.
Moreover, CPT 99457 will be billed ‘incident to’ under general supervision. Medicare providers can contract third-party RPM companies to assist with RPM services. They are ultimately offering providers the opportunity to manage more patients. This results in more company revenue without significantly impacting workflow. CPT 99457 is billed monthly.
99458
CPT 99458 encompasses reimbursement for each additional 20 minutes of RPM services, with a maximum of 60 minutes in a calendar month. Similar to CPT 99457, documentation of how the time is distributed is required. The average national payment rate for CPT 99458 is $38.64.
99091
This is the newest code, introduced in 2022, with more requirements than the preceding codes. It covers a minimum of 30 minutes in a calendar month for the time it takes clinical staff to gather, interpret, and process data that a patient transmits. CPT code 99091 covers at least one communication, occurring by phone or email, where medical management or monitor advising occurs. The average national payment rate for CPT 99091 is $52.71.
Enhancing Chronic Care Management and Remote Patient Monitoring with Tenovi
Tenovi remote patient monitoring devices and CCM billing platform make starting and scaling remote patient monitoring for chronic care management programs easy. Our custom suite of FDA-cleared remote monitoring devices and physician dashboard and billing platform provides solutions for managing chronic conditions efficiently and cost-effectively. Please request a free demo to learn more about how we can help your organization achieve its care management goals.
