What is Remote Patient Monitoring (RPM)?

 

Remote Patient Monitoring (RPM) refers to the collection of patient-generated health data by a patient or caregiver that is digitally stored and transmitted to a healthcare professional for review and care management or treatment plan intervention.

Click Here for more information about What is required for RPM?

What is required for RPM?

  •  RPM requires patient consent be obtained at the time services are furnished by the auxiliary personnel for physiologic monitoring of patients with acute and/or chronic conditions, under general supervision by the billing practitioner.
  •  RPM must be medically necessary
  •  RPM must be ordered in the patient medical record

What is required for CMS? 

  • A provider order supporting medical necessity RPM services must be initiated during a face-to-face visit (or telehealth during the PHE) for patients not seen within the past year
  • The RPM device must meet the FDA’s definition of a “medical device” (does not have to be FDA-approved, but must still meet the definition)
  • The patient must be using RPM for a minimum of 16 days to bill for services (Refers to CPT 99453 & 99454) Mandatory interactive communication with the patient (Refers to CPT 99457 &99458)What is required for CMS 1.

Click Here to view Important Remote Patient Monitoring CPT Codes

CPT 99453- Service Initiation

Remote monitoring of physiologic parameter(s) (e.g., weight), initial; set-up and patient education on use of equipment

✔One time code only, one or multiple equipment.

✔Can only bill after the first 16 days of reading in 30 days occurred

CPT 99454- Data Transmission

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate). Monthly data transmission

✔One time code per month with one or multiple equipment used.

✔Can only bill after the 16 days of reading in 30 days occurred

CPT 99457- Treatment Management

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month initial 20 minutes

✔One time per month

✔One or multiple equipment used

✔Can Not bill without a phone call to patient or caregiver

CPT 99458- Treatment Management

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month additional 20 minutes

✔Unlimited times per month

✔One or multiple equipment used

✔Can Not bill without a phone call to patient or caregiver

CMS 2020 Final Rule on RPM “Incident to” billing of CPT Code 99457

When the CPT codes for RPM were first created in 2018 CMS stated that RPM services could only be delivered by a physician and not by an “auxiliary personnel incident to the practitioner’s professional services.” An “incident to” service is defined as a service rendered under the supervision of a physician and/or qualified health care professional and then billed to Medicare in the name of the physician and/or qualified healthcare professional.

In April of 2019, the CMS stated that it would allow for “incident to” billing by auxiliary personnel if they were under direct supervision, which meant they were in the same building at the very same time. This new rule allows for general supervision instead of the direct supervision that was required prior to April of 2019; thus, CPT codes 99457 and 99458 can be billed under general rather than direct supervision.

General supervision allows physicians to use telemedicine to conduct general supervision with their auxiliary staff. Furthermore, this rule states that the physician and/or other qualified healthcare professional who is supervising auxiliary staff does not have to treat the patient receiving RPM services, yet the supervising physician/qualified healthcare professional can bill Medicare for the “incident to services”.

This new rule extends the flexibility of the RPM services and does not exclusively put the burden solely on the physician and/or qualified healthcare professional. This rule has changed the landscape of the current business models being used for RPM services and will continue to enhance them greatly.

New RPM Code for Extra 20 Minutes

The CMS also created a new rule that will allow for billing after the first 20 minutes of RPM services, which is currently billed under CPT 99457. Patients who received an additional 20 minutes of RPM services and require interactive communication with clinical staff/physician/qualified healthcare professional can be billed under CPT code 99458. It’s estimated that reimbursement will be at the rate of approximately $43 per month.

In conclusion, these new rules and CPT codes demonstrate that the CMS recognizes the importance of RPM services and its power to minimize the gaps in our current healthcare system. All patients can benefit from these services and these changes will certainly increase providers’ chances to adopt a medical model that includes RPM services.

 

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Kelly Ladner, truMED CEO

Kelly has more than 17 years of experience in medical technologies with a heavy focus in surgical device sales, global market development for surgical robotics as well as advanced energy market penetration and its use in the O.R. He has consistently been a top performer for multiple healthcare organizations as well as leadership roles for elite specialty sales and training divisions. His wide range of experience coupled with a vast global network in the healthcare space is a fundamental piece to the leadership and success for truMED in this new and emerging market.

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Evan Wooldridge

Evan’s career spans 17 years in healthcare with extensive sales and sales management experience in the surgical device market. He has a proven track record of successfully achieving plan and driving others to reach their full potential. Evan is responsible for building and leading sales and marketing efforts, while also building out truMED’s software applications.

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Richard Creagh

With nearly 20 years of experience in a variety of technology, medical device manufacturing, and healthcare companies, Richard will serve as truMED’s president of European operations. He has deep knowledge of neural networks, machine learning, and artificial intelligence.

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Darla Young

Darla has more than 25 years of financial advisory experience serving a broad range of industries with an emphasis on profitability, business growth and strategic planning. As a CFO for a software development company for more than a decade, Darla worked with companies in varied spaces while proprietary software was in the early stages.

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Michael Green

Dr. Michael L. Green, Jr. is a board certified general surgeon with fellowship training in advanced laparoscopic general and bariatric surgery. He has been practicing for 18 years in the Dallas/Fort Worth area and has been instrumental in training medical professionals in the surgical setting. Dr. Green maintains multiple leadership roles at his local hospital and for various professional medical associations.

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Nahaniel Lytle

Dr. Nathaniel Lytle is a bariatric surgeon specializing in bariatric care, the treatment of diseases of the esophagus and stomach, complex hernia repairs and solid organ surgery. He is board certified in general surgery, a member of the Society of American Gastrointestinal and Endoscopic Surgeons, a member of the American College of Surgeons, and a member of the American Medical Association.

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Parham Mora

Dr. Parham Mora is a general surgery specialist with more than 30 years of experience in the medical field, providing both general and bariatric surgery services. A member of the American Society for Metabolic and Bariatric Surgery, Medical Association of the State of Alabama (MASA), the Society of Laparoscopic Surgeons, the Autauga County Medical Society, Dr. Mora is board certified with the American Board of Surgery.

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John Conneely

Dr. John Barry Conneely is a consultant general surgeon specializing in foregut, hepatobiliary and metabolic surgery at the Mater Misericordiae University Hospital and the Mater Private Hospital, in Dublin, Ireland. He is an expert in minimally invasive hepatobiliary and bariatric surgery with additional expertise in abdominal transplantation, advanced surgical oncology and robotics.

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Michael Gorton

Michael Gorton is a successful serial entrepreneur who has created tens of billions of dollars in net worth from companies he started. A pioneer of telemedicine and digital health, he helped create what is becoming a trillion-dollar industry. He is a nationally recognized best-selling author.

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Carel Le Roux

Carel Le Roux is the chairman of the Stratification of Obese Phenotypes to Optimize Future Obesity Therapy (SOPHIA) and a world-renowned expert in metabolic medicine. He has more than 20 years of experience in metabolic research.

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Ian Gargan

Ian is a medical doctor, qualified psychologist, and the CEO of PHIN (Private Healthcare Information Network). Prior to PHIN, he was the founder, Chief Medical Officer, and CEO of Imagine Health, as well as a consultant medical practitioner and clinical psychologist.

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