The CPT code 99453 reimbursement, established by the Centers for Medicare and Medicaid Services (CMS), compensates providers for the continuous supply of devices used in remote patient monitoring (RPM). The 2024 CMS final rule enabled companies providing RPM services to generate revenue while improving patient care experiences and health outcomes. Each of the 5 CPT codes (99453, 99454, 99091, 99457, 99458) has specific guidelines and qualifications for remote patient monitoring reimbursement.
CPT Code 99453 reimburses for supplying the device for daily recording or programmed alert transmissions. This article answers commonly asked questions surrounding CPT 99453.
Which RPM Devices Qualify for CPT Code 99453 Reimbursement?
CPT code 99453 allows clinicians to use remote patient monitoring devices to help patients manage chronic and acute conditions that require vital sign measurements such as weight, blood glucose, blood pressure, peak expiratory flow, oxygen saturation, pulse rate, and more. In addition, health organizations may use several FDA-cleared remote patient monitoring devices to measure patient vital signs.
Below is a list of qualified devices approved for reimbursement under CPT 99543.
Who Qualifies for CPT 99453?
In the 2021 Final Rule, CMS confirmed that clinicians may provide RPM services for Medicare patients with acute and chronic care conditions. Therefore, all remote patients covered by Medicare can participate in remote patient monitoring.
What Services Are Billable Under 99453?
CPT code 99453 services cover continuous device supply and patient monitoring. The code also reimburses costs for leasing a remote patient-monitoring medical device. In addition, 99453 pays for supplying the device for daily recording or programmed alert transmissions. If the primary physician or qualified healthcare professional orders the devices, they must show invoices and the services related to each device.
What is the Reimbursement Rate for Code 99453?
The 2024 average national payment rate for CPT code 99453 is $19.32. This code requires 16 days of patient vital sign data during a 30-day billing period.
How Often Can CPT 99453 Be Billed?
CPT code 99453 can be used once and billed once per patient for data collection for at least 16 days in a 30-day period (episode of care days; not calendar month days).
Do RPM Devices Have to be FDA-Cleared to Bill for CPT Code 99453?
According to CMS, devices must be “medical devices as defined by the FDA.” Some providers may require using FDA-cleared Class II remote patient monitoring devices. If a medical device is marketed as FDA-registered, it does not mean it is FDA-cleared. With FDA-cleared remote patient monitoring medical devices, healthcare organizations and patients can rest assured that they receive instant, reliable, and secure patient health data remotely.
In general, the majority of remote patient monitoring devices require FDA Clearance. However, please remember that FDA approval is required for Class III medical devices with the most significant potential risk. For example, an implanted pacemaker is a Class III medical device.
All Medicare beneficiaries are eligible to participate in remote patient monitoring; however, some requirements exist, such as who qualifies for remote patient monitoring. Here’s a summary of the requirements to bill for remote patient monitoring CPT Code 99457 and all CPT codes 2024 are as follows:
- The RPM device must fit within the FDA’s definition of a medical device.
- A Patient must opt-in for the service before ordering the remote patient monitoring device.
- The patient must use the RPM device for at least 16 days a month.
- Data collection must be HIPAA-compliant.
Can a Third-Party Deliver RPM Services on Behalf of Healthcare Clinicians?
Clinicians may bill remote patient monitoring as ‘incident to,” which allows a third-party company to perform RPM services under the general supervision of the billing clinician. This means a third-party remote patient monitoring solution partner can offer technical support and education on activating and using the remote patient monitoring device. Third-party partners can help make workflows more efficient by cutting down on the logistical challenges associated with the remote monitoring of patients.
Understanding CPT Code 99453
Remote patient monitoring and CPT code 99453 offer healthcare providers an opportunity to enhance patient care while creating a new revenue stream. By understanding the guidelines, device requirements, and billing procedures, clinicians can effectively implement RPM programs that benefit both their practice and their patients.
Tenovi works exclusively with companies offering healthcare providers remote patient monitoring solutions. In addition, we serve RPM service and software, chronic care management, and telehealth companies. You can use the Tenovi dashboard or your platform because we have well-supported APIs for data, device activation, and fulfillment. Book a free demo with Tenovi today.
