If you are looking for up-to-date remote patient monitoring (RPM) CPT codes for 2024, this comprehensive guide provides a quick reference for the 5 RPM CPT codes, reimbursement rates, and billing requirements. The cost fee structure for the RPM CPT codes in 2024 (99454, 99457, 99458, 99091) was revised, leading to slightly reduced reimbursement rates.
Follow along to ensure your practice maximizes its RPM potential while complying with the latest CMS guidelines.
Remote Patient Monitoring CPT Codes 2024
Qualified healthcare professionals know the Centers for Medicare and Medicaid Services (CMS) update RPM CPT billing codes yearly to incentivize healthcare providers to implement RPM for their patients. The following sections provide an overview of what the new billing guidelines for remote patient monitoring CPT codes 2024 cover, including the average reimbursement rate and requirements for RPM programs.
99453
RPM CPT code 99453 covers initial one-time per device set-up and patient education on using equipment for remote physiological monitoring, such as blood pressure, pulse oximetry, and blood glucose. Furthermore, this one-time code is billed after the initial 16 days of monitoring in a 30-day period (episode of care days.) The average national payment rate for CPT 99453 is $19.65.
99454
CPT code 99454 covers the cost of providing devices, transmitting data, data collection, and reporting services. It may be used once per month per patient regardless of the number of devices the patient uses. The patient must use the device for at least 16 days per month. In addition, CPT 99454 is billable every 30 days. The average national payment rate for this code is $46.50.
99457
RPM CPT code 99457 comprises an initial 20 cumulative minutes of RPM services by a physician, clinical staff, or qualified healthcare professional over a 30-day period. 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 can be billed as a ‘incident to’ under general supervision. This means that Medicare providers can contract third-party RPM companies to outsource and assist with care manager RPM services. Ultimately offering providers the opportunity to manage more patients. Thus resulting in more company revenue without significantly impacting workflow. Code 99457 is billed one time each during a 30-day calendar month.
99458
CPT code 99458 encompasses reimbursement for unlimited additional increments of 20 minutes of RPM services, after the initial 20-minute minimum is met. Similar to 99457, documentation of how the time is distributed is required. The average national payment rate for CPT 99458 is $38.64.
99091
RPM CPT code 99091 is the newest code introduced in 2022. It has more requirements than the preceding codes. Code 99091 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. It also covers at least one communication, occurring by phone or email, where medical management or monitor advising occurs. The average national payment rate for code 99091 is $52.71.
Billing Requirements for Remote Patient Monitoring
All Medicare beneficiaries can participate in remote patient monitoring; however, some requirements like who qualifies for remote patient monitoring exist. A summary of the requirements to bill for remote patient monitoring 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.
- A new patient evaluation is needed for patients new to RPM.
- Patients already enrolled in RPM during the Public Health Emergency (PHE) can continue receiving RPM services.
- The patient must use the RPM device for at least 16 days a month to bill for CPT codes 99453 and 99454.
- Data collection must be HIPAA-compliant.
Ready to Try Remote Patient Monitoring?
Medicare recognizes that remote patient monitoring programs play a significant role in the future of value-based patient care. There are many benefits of remote patient monitoring in remote health. By implementing remote patient monitoring solutions into the workflow, clinicians can improve the quality of care and generate more revenue. The CMS 2025 Proposed Rule does not suggest any major updates to codes for 2025. The Final Rule is expected to be released in November, 2024.
If you are in search of billing requirements and CPT codes for remote therapeutic monitoring (RTM) CPT codes, visit this blog post on RTM CPT codes. If you are a chronic care, telehealth, RPM services, or software company member, book a consultation and free demo to learn more about leveraging Tenovi’s remote patient monitoring devices and service solutions.
