Remote physiologic monitoring codes play a significant role while billing remote physiologic
procedures. By accelerating the adoption of telehealth and telemedicine, Covid-19 pandemic
simultaneously increased the implementation of remote physiologic monitoring (RPM). It means that
medical coders who document patients with conditions such as obesity, diabetes, hypertension, or
chronic obstructive pulmonary disease (COPD) are supposed to understand the CPT RPM codes.
A complete guide to remote physiology coding including few much needed tips to implement RPM in
healthcare practice will add value to the practice and business. You also need to check if the codes
are being used appropriately. This article also gives knowledge on use of CPT codes and how to
differentiate them for proper reimbursements.
Initiating Remote Physiologic Monitoring to the patient:
This particular one requires 99453- Remote monitoring of physiologic parameter. For example: weight,
blood pressure, pulse oximetry, respiratory flow rate, initial set-up and patient education on use
of equipment.
As per CPT guidelines, use 99453 when the physician or other qualified healthcare professional (QHP)
writes an order for RPM services and the practice sets up the equipment and gives an idea to the
patient on the use of the equipment.
Remote physiologic monitoring device is “a medical device as defined by the U.S. Food and Drug
Administration FDA,” per CPT guidelines. It means that the device is capable of transmitting data to
the prescribing healthcare professional.
Additionally, CPT insists not to report codes, when the monitoring is less than 16 days as these
services are included in other codes. The code 95250 is used for Ambulatory continuous glucose
monitoring of interstitial tissue fluid via a subcutaneous sensor that requires at least 72 hours of
monitoring.
Finally, healthcare professional must report 99453 only once for each episode of care, defined by
CPT at the beginning when the remote monitoring physiologic service is initiated and ended with
attainment of targeted treatment goals.
Medicare and Medicaid Fee Schedule 2021 updates:
The Centers for Medicare and Medicaid changed numerous CPT guidelines affecting the initial phase of
remote physiologic monitoring. They include:
Patients are at present allowed to provide consent to RPM at the time of service rather than prior
to the service commencement.
Clinical staff and other auxiliary personnel are at present permitted to set up RPM devices and
provide patient education. Personnel not employed by the ordering physician, meaning vendors
supplying RPM equipment, can also now set up devices and educate the patients.
Healthcare professionals yet cannot provide RPM services to new patients. However, they can now
furnish RPM to patients who are established in a practice through a prior evaluation and management
(E/M) service conducted either face-to-face or telehealth.
Receiving RPM Data:
For the above, healthcare professionals will have to use 99454 for the devices supply with daily
recordings or programmed alerts transmission, every 30 days.
This particular code stays appropriate if the healthcare provider supplies the equipment and the
healthcare practice receives the RPM data or alerts for a minimum of 16 days in the 30 days of the
code’s timeframe.
As per 99453, CPT tells the provider not to report the code in case monitoring is less than 16 days,
and when all these services are included in other codes. However, unlike 99453, healthcare
professionals can report 99454 once every 30 days for the duration of the service.
Interpreting RPM Data:
For this, use the code 99091- Collection and interpretation of physiologic data. For example: ECG,
blood pressure, glucose monitoring that’s digitally stored and/or transmitted by the patient and/or
caregiver to the physician or other qualified health care professional, qualified by education,
training, licensure or regulation when applicable requiring a minimum of 30 minutes of time, each 30
days.
According to the descriptor, use code 99091 whenever the healthcare provider collects and interprets
patient- or caregiver-transmitted RPM data. Before billing 99091, healthcare professionals will have
to make sure the service is provided by a physician or other QHP.
With the code 99454, healthcare provider can also report 99091 once every 30 days for the episode of
care. And, as a time-based code, the provider will have to ensure if the documentation states that
the provider spent at least 30 minutes during those 30 days collecting and interpreting the patient
data.
Don’t separately report 99454 when the work is folded into an E/M service for the patient. The
January 2019 issue of CPT assistant reveals that if the services described by code 99091 are
provided on the same day the patient is present for an E/M service, these services should be
considered as part of the E/M service and should not be reported separately.
Remote Physiologic Monitoring Treatment Management:
For the above, use the code 99457- remote physiologic monitoring treatment. It covers management
services, clinical staff or physician and other qualified health care professional’s time in a
calendar month requiring interactive communication with the patient or caregiver during the month,
first 20 minutes, and its add-on code +99458 each additional 20 minutes.
Use these codes, instead of 99091, for a physician or other Quality Healthcare Professional:
It uses RPM data for patient management when the patient is under a care plan.
It communicates with the patient or caregiver using interactive communication.
As the patient must be under a care plan, it is possible to report 99457 and add +99458 with
services such as 99439 – 99491- Chronic care management services, 99487 – 99489- Complex chronic
care management services, and 99495 -99496- Transitional care management services.
As per
CPT guidelines,
there might be no overlapping time between codes 99457 and 99458 when performing these services in a
single month.
Along with 99454 and 99091, professionals can report 99457 and add +99458 once every 30 days for the
duration of the service. And like 99091, both 99457 and +99458 are time-based codes and require to
be documented as such. Always remember that code +99458 allows you to bill for additional time above
and beyond the base code’s first 20 minutes in 20-minute increments.
Medicare and Medicaid Fee Schedule 2021 updates:
The Centers for Medicare and Medicaid Services clarifies that for 99457 and +99458, providers can
count time once engaged in interactive communication with the patient along with time providing and
coordinating care management services related to the patient’s condition.
“Physiologic” limitations: the challenge of reimbursement in general terms
There is no specific definition for physiologic, which has created considerable confusion within the
revenue payback community.
This confusion has caused healthcare providers and insurance payers to question which type of
technology and physiologic markers qualify for remote “physiologic” monitoring reimbursement by
limiting adoption.
Back in November 2018, CMS had extended coverage and payment for CPT remote physiologic monitoring
codes 99453, 99454, and remote physiologic monitoring treatment management services code 99457.
In 2019 November, CMS also announced that it would adopt, cover, and pay CPT code 99458 for each
additional 20 min, from the beginning of January 1, 2020.
Then,in the final rule, it has acknowledged the need for clarification of the term physiologic and
mentioned that they would consider these issues in the
However, the term “physiologic” does not have any formal definition set by CMS within the rule,
policy, and listing of chronic diseases and associated terms.
There are several examples of why physiologic definition limits or decreases the application of
remote monitoring.
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