Are you looking for a concise article that breaks down 2023 Medicare reimbursement rates for remote patient monitoring? If so, you have come to the right place. The CY 2023 Physician Fee Schedule Final Rule, containing 2,953 pages of detailed policy changes was released on November 1, 2022. The final rule breaks down RPM and telehealth reimbursement policy. The RPM reimbursement rates referenced in this article are effective January 1, 2023.
The American Medical Association (AMA) projects physician shortages of 37,800 and 124,000 by 2034. What’s more, AMA specifically cites telehealth and technology as potential solutions to the problem, adding that remote patient monitoring can help reduce the burden on practitioners, but the technology must be readily available and accessible. For that reason, we also provide tips and insights into how to choose the best 2023 outsourced remote patient monitoring services for your healthcare partners.
Updates for 2023 Medicare Reimbursement in RPM
Since 2019, CMS remote patient monitoring CPT codes have made it easier for healthcare providers to adopt remote patient monitoring for their patients. Yearly Medicare RPM reimbursement updates and modifications to remote patient monitoring CPT codes remain expected. For 2023, CMS did not add the Proposed Rule RPM G codes to the final rule.
Therefore, the two key takeaways for 2023 Medicare reimbursement rates for remote patient monitoring were:
- Medicare reimbursement rates were updated for 2023.
- RPM CPT codes remain unchanged for 2023: 99453, 99454, 99457, 99458, and 99091.
Next, we review CPT codes for 2023, including average reimbursement rate and requirements.
RPM 2023 CPT Code Medicare Reimbursement Rates
The following round number 2023 Medicare reimbursement rates for remote patient monitoring rates are based on non-facility national averages and vary by region.
CPT Code 99453: Medicare 2023 RPM Reimbursement
This first code reimburses for device set-up and patient education for remote patient monitoring device equipment used for vital sign monitoring such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate, and weight. This is a one-time code to be billed following the initial 16 days of monitoring. The average national payment rate for CPT 99453 is $19.
CPT Code 99454: Medicare 2023 RPM Reimbursement
The second code pays for daily recording or programmed alert transmissions. Unlike the previous code, it may be used more than one time. This is provided that the patient uses the device at least 16 days per month. CPT 99454 may be billed every 30 days. The average national payment rate for CPT 99454 is $49.
CPT Code 99457: Medicare 2023 RPM Reimbursement
Code 99457 is the third code used for the initial 20 minutes of treatment management. An unspecified portion of the 20 minutes requires interactive remote communication with the patient. A video call, phone call, email, and text messaging suffices. The average national payment rate for CPT 99457 is $48.
It is important to note: CPT 99457 is billed “incident to” under general supervision. This allows Medicare providers to contract third-party remote patient monitoring companies to assist with RPM services. Thus, enabling healthcare organizations to care for more patients and generate increased revenue without significantly impacting workflows.
CPT Code 99458: Medicare 2023 RPM Reimbursement
This code continues to cover each additional 20 minutes of RPM services, with a maximum of 60 minutes per month. Like CPT 99457, documentation of how this time is distributed is required. The average national payment rate for CPT 99458 is $39.
CPT Code 99091: Medicare 2023 RPM Reimbursement
Finally, this CPT code pays for a minimum of 30 minutes in a calendar month of clinical staff time on gathering, interpreting, and processing data transmitted by a patient. This includes 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 $53.
How Outsourcing RPM Can Help With 2023 Medicare Reimbursement
The American Medical Association (AMA) projects physician shortages of 37,800 and 124,000 by 2034 and specifically cites telehealth and technology as potential solutions. AMA says that remote patient monitoring can help reduce the burden on practitioners, but the technology must be available and accessible. 2023 Medicare reimbursement for remote patient monitoring offers healthcare organizations the opportunity to increase patient volume, drive better patient engagement, and increase revenue generation.
But how do you identify the best remote patient monitoring companies for your 2023 healthcare partners? Keep in mind that not all RPM programs are equal! The next section provides tips and suggestions for what software and service, telehealth, and chronic management companies want to look for in third-party remote patient monitoring companies.
What to Look for in RPM Outsourcing Companies
First, the level of outsourcing your partner requires is a key point to getting started with reviewing remote patient monitoring outsourcing companies. Myriad pricing structures are used, depending upon how much of the RPM process the healthcare practice wants to handle.
Full-service models can cover RPM tasks such as:
- FDA-cleared device set-up
- Patient education
- HIPAA-compliant technical support
- Data review
- Patient interaction
- Device shipping/fulfillment
Conversely, basic service models generally only cover device set-up and patient education. This leaves physicians fulfilling data reviews and performing patient interaction. A basic service model certainly yields more return on investment (ROI) for the healthcare organization. Though, it also adds more tasks to physicians’ workload.
This means paying close attention to all costs associated with the physician’s time is vital. Additional components to consider regarding RPM services include the cost of housing and shipping devices to patients, onboarding patients, and ongoing HIPAA-compliant technical support.
Finally, onboarding the medical organization and smoothly integrating the devices and software into the healthcare provider’s electronic health record system (EHR). Additionally, healthcare organizations need reliable ongoing technical support. Therefore, to reap the benefits of the 2023 Medicare reimbursements for Remote Patient Monitoring, a full-service model with a top-notch remote patient services company may be worth the investment.
Tenovi 2023 Remote Patient Service Solutions
Tenovi works exclusively with companies that would like to offer remote patient monitoring solutions to healthcare providers. The companies we serve include:
- RPM Service Companies
- RPM Software Companies
- Chronic Care Management Companies
- Telehealth Companies
Tenovi is committed to enhancing preventive patient care and simplifying the process of managing patient data for healthcare providers. We are the only platform that includes RPM devices for neuromuscular rehab. Our easy-to-use devices automatically transmit data through our cellular gateway to help optimize care for patients with chronic care conditions such as heart disease, COPD, diabetes, kidney disease, and hypertension. Get in touch to schedule a free demo and consultation.
