Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are crucial in providing healthcare services to underserved communities. With the Centers for Medicare & Medicaid Services (CMS) implementing new billing changes effective January 1, 2025, these organizations now have a significant opportunity to expand their use of Remote Patient Monitoring (RPM). This article explores the CMS update and how it impacts FQHCs and RPM adoption in these settings.
The 2025 CMS Update for FQHCs and RPM
As of January 1, 2025, CMS allows FQHCs and RHCs to bill for RPM services using individual Current Procedural Terminology (CPT) codes instead of the generalized “G0511” code. This shift enables these organizations to bill for specific RPM services provided to patients. The newly applicable 2025 CPT codes include:
- 99453: Initial setup and patient education on the use of RPM devices.
- 99454: Supply of RPM devices and data transmission every 30 days.
- 99457: Remote monitoring and management of a patient, including at least 20 minutes of clinical staff or physician time per month.
- 99458: Used for each additional 20 minutes of RPM management services, supplementary to 99457.
This change allows for more precise billing and reflects the specific RPM services delivered, providing a financial incentive for FQHCs and program expansion.
Why This Change Matters for FQHCs
- Improved Reimbursement Opportunities for FQHCs: By using CPT codes 99453, 99454, 99457, and 99458, FQHCs and RHCs can better align their billing with the actual services provided, potentially increasing revenue for RPM programs.
- Encouraging RPM Adoption in FQHCs: RPM enables healthcare providers to remotely monitor and manage patients with chronic conditions like diabetes, hypertension, and heart disease. The ability to bill for these services individually creates a financial framework for FQHCs and RHCs to invest in RPM technologies and devices.
- Enhanced Patient Care Through RPM in FQHCs: Access to RPM services improves care coordination and allows providers to proactively address patient health issues, leading to better outcomes and reduced hospitalizations.
- Lowering the overall cost of diabetes care: Most glucometers do not support test strips covered by most US insurance companies, nor do pharmacies commonly stock them. However, FQHCs can reduce the total cost of diabetes care by integrating TRUE METRIX® AIR blood glucose meter to Tenovi’s Cellular Gateway. This enables providers to support a commonly available glucose monitor with test trips found on many formularies.
Steps to Implement RPM in Your FQHC or RHC
If your organization is looking to take advantage of the new CMS billing changes for FQHCs and remote patient monitoring, consider the following steps:
- Assess Your Patient Population for RPM: Identify patient groups that would benefit the most from RPM, such as those with chronic conditions requiring frequent monitoring.
- Choose the Right RPM Devices for FQHCs: Invest in cellular-enabled devices, such as blood pressure monitors and weight scales, to ensure ease of use and seamless data transmission.
- Train Your Staff on RPM for FQHCs: Educate your clinical and administrative staff on RPM workflows, device setup, and documentation requirements for billing CPT codes.
- Update Your Billing Processes for RPM: Work with your billing team to incorporate the new CPT codes into your processes and ensure compliance with CMS guidelines.
- Partner with Trusted Vendors for RPM Programs: Collaborate with RPM solution providers that offer end-to-end support, including device provisioning, data management, and technical support.
Looking Ahead for FQHCs and RPM
The 2025 CMS update is significant for FQHCs and RHCs, empowering them to deliver high-quality care through RPM while optimizing reimbursement. By leveraging these changes, your organization can enhance patient outcomes, improve operational efficiency, and strengthen financial sustainability.
Tenovi provides cellular-enabled RPM devices and solutions tailored for FQHCs and RHCs. Our suite of devices, including Welch Allyn blood pressure monitors and weight scales, integrates seamlessly with your workflows, enabling efficient RPM program implementation. With our Cellular Gateway serving as the lifeline for all connected devices, we ensure reliable data transmission and simplified operations. To learn more about implementing RPM in your FQHC or RHC, contact Tenovi today.
