Billing for Remote Patient Monitoring CPT Codes in 2021

Billing for Remote Patient Monitoring CPT Codes in 2021
CPT codes or, current procedural terminology codes, are crucial not only in the process of incorporating Remote Patient Monitoring into your practice, but getting properly paid for your Remote Patient Monitoring services. CPT codes are used to bill Remote Patient Monitoring to Centers for Medicare and Medicaid Services (CMS). These codes translate into revenue, making Remote Patient Monitoring a sustainable and financially beneficial program for small and medium size medical providers.

In 2021, CMS has expanded the role of remote patient monitoring, including building on CPT codes, adding a wider variety of the types of clinicians who can perform Remote Patient Monitoring tasks, and more. Now that CMS has made the program more robust, it’s important to understand how to bill for these services. 

CMS has expanded its Remote Patient Monitoring Program and Billable CPT Codes

The most recent and important changes in Remote Patient Monitoring revolve around CMS clarifying what exactly defines billable services and what qualifies as a Remote Patient Monitoring service in 2021. The most recent CPT code book has defined Remote Patient Monitoring devices as medical devices that automatically collect and transmit patient data for the purpose of treatment and diagnosis. To bill some of these CPT codes, 99453 and 99454 specifically, the Remote Patient Monitoring must consist of at least 16 days worth of data within a 30 day period. While the COVID-19 Public Health Emergency (PHE) is in effect, CMS is requiring fewer than 16 days worth of data within a 30 day period as long as all requirements are met. The first of these, 99453, “can be billed only once per period of care, defined as “beginning when the remote physiologic monitoring service is initiated and ends with attainment of targeted treatment goals.” 

What are the Remote Patient Monitoring CPT Codes You Need to Know for 2021?

  • CPT code 99453 compensates providers for any time associated with onboarding and educating a patient while a clinical staff member sets up the necessary Remote Patient Monitoring devices. With 100Plus, providers can earn $24.58 per one time patient under this code.
  • CPT Code 99454 reimburses providers for supplying said patient with a Remote Patient Monitoring device for a 30-day period. 100Plus clients can take in $990 per patient annually using this CPT code.
  • CPT Code 99457 compensates for time spent monitoring physiologic parameters (weight blood pressure, pulse oximetry, and respirator flow rate, for example). This comes in at about  20 minutes per calendar month and can earn providers $736 per patient annually. 
  • CPT Code 99458 is an add-on to code 99457 that reimburses providers for each additional 20 minutes per month of interactive monitoring. This code can provide up to $1,174 per patient annually to medical providers. 
  • CPT code 99091 focuses on data collected within a 30-day period to be analyzed remotely by a physician or medical provider. While this CPT code is still considered valid by the CMS, the codes listed above better represent the various situations that require billing. This code cannot be billed in the same calendar month as 99457 and 99458.

Who can perform and bill for Remote Patient Monitoring services?

Remote Patient Monitoring services can be provided by companies like 100Plus who deliver, set up, and maintain Remote Patient Monitoring devices. These services can be performed and billed by clinicians and medical providers to CMS by way of CPT codes.

Who qualifies for Remote Patient Monitoring services?

Another major change within Remote Patient Monitoring services is expansion of the eligible population. Medical providers can now conduct Remote Patient Monitoring without an initial new patient visit and evaluation. Remote Patient Monitoring was previously limited to established patients. Due to the current public health emergency, that rule has been amended so doctors can use remote communication for face-to-face visits to establish a virtual relationship.

How can your practice benefit from billing for remote patient monitoring CPT codes?

Billing for Remote Patient Monitoring via these CPT codes is a great way for small and medium size medical providers and practices to take in additional income and increase revenue. Remote Patient Monitoring simultaneously mitigates COVID-19 exposure and takes the strain off of facilities during this global health crisis. With the Remote Patient Monitoring and CPT code changes made by CMS, providers can now obtain and sustain additional automated revenue without any in-person interaction. 

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