Remote patient monitoring programs are a win-win for primary care practices and the patients they serve. Billing for remote patient monitoring generates additional revenue for medical practices that allows providers to improve their quality of care. To successfully bill for RPM services, you’ll need to know the various CPT codes associated with RPM services and understand how different insurers reimburse for these services. This article covers each RPM billing code individually, explaining how and when to use it, and concludes by reviewing RPM coverage guidelines for patients on Medicare and private insurance.
Remote Patient Monitoring Billing Codes and How to Use Them
Accurate insurance billing is one of the most important ingredients to running a profitable primary care practice. Knowing how and when to use RPM CPT codes will enable you to fully bill for all allowable RPM services, ensuring a more robust and reliable revenue stream.
CPT 99453
Use CPT 99453 to bill for the initial setup of connected health devices used to monitor patient health parameters like respiratory flow rate, blood pressure, and pulse oximetry. Services under this code include device set-up and patient education on the proper use of equipment. The 2022 national average for Medicare reimbursement when using this billing code is $18.48 per patient for a one-time initial setup.
CPT 99454
Use CPT 99454 to bill for at least 16 days of remote patient monitoring services per 30-day period. This code requires that the RPM device supply readings or deliver programmed alerts that transmit during at least 16 days within the 30-day period. The 2022 national average for Medicare reimbursement when using this billing code is $55.77 per patient per month, or $668.64 per patient annually.
CPT 99457
CPT 99457 is used to bill for remote physiologic monitoring treatment management services of 20 minutes or more of a clinical staff/physician/other qualified healthcare professional time. In order to use this billing code, there must be at least one interactive communication between the patient and their healthcare provider per month. The 2022 national average for Medicare reimbursement when using this billing code is $50.18 per patient per month, or $602.16 per patient annually.
CPT 99458
CPT 99458 carries the same description and requirements as CPT 99457 but allows providers to bill for a second interactive communication during the month being billed. The 2022 national average for Medicare reimbursement when using this billing code is $40.84 per patient per month, or $490.08 per patient annually.
Medicare Insurance Guidelines for RPM Services
The Centers for Medicare and Medicaid Services (CMS) have four requirements for practice billing for remote patient monitoring services. Documenting that these guidelines have been followed will streamline the reimbursement process and ensure you have adequate proof that these requirements were followed.
Patient copay amount
CMS requires that patients covered under Medicare Part B be charged a 20% copayment. Choosing to waive these copayments may result in federal fines for providers.
Patient consent
Providers must gain consent from patients to provide remote patient monitoring services. This consent can be provided prior to delivering the service, either verbally or in writing.
Required monthly monitoring duration
In order to bill CMS for remote patient monitoring services, patients must be monitored for at least 16 days per billing period. Health data collected by remote patient monitoring devices can be wirelessly synced for evaluation by the patient’s provider.
RPM service must be ordered by a physician or other healthcare provider
In order to initiate patient participation in a remote patient monitoring program, RPM must be ordered by the patient’s doctor or other qualified health professional. These individuals could include a nurse practitioner, certified nurse specialist, or a physician assistant.
State Medicaid Coverage for RPM Services
Patients covered by state Medicaid programs are often eligible for remote patient monitoring programs. In fact, according to the Center for Connected Health Policy (CCHP), over half of state Medicaid programs will provide reimbursement for RPM. Since every state administers its own Medicaid program, guidelines and coverage restrictions vary. This comprehensive resource from CCHP lists the remote patient monitoring policies for each state Medicaid program.
Commercial Insurance Coverage for RPM Services
Commercial insurance providers have embraced remote patient monitoring technology. This trend toward greater coverage was accelerated during the height of the COVID-19 pandemic and hasn’t shown signs of slowing. As a result, the vast majority of private health insurers now reimburse for remote patient monitoring services for eligible patients covered under one of their policies.
Grow Your RPM Program with Withings Health Solutions
Withings Health Solutions is an industry leader in remote patient monitoring. Our FDA-approved medical-grade devices feature intuitive, patient-friendly designs that create higher levels of user engagement. Withings RPM, an all-in-one remote patient monitoring solution, comes with an AI-powered digital assistant that lets participants engage more fully.
Additionally, practices can automatically record time spent on patients for streamlined claim creation. With Withings RPM, you can grow your practice by easily tracking time spent on the platform by your practice to bill CPT codes and get reimbursed for remote patient monitoring. You can also automatically track the time spent monitoring patient measurements to build comprehensive, CMS-compliant billing reports. The solution also builds audit reports to ensure that your RPM records are audit-proof. You can have all RPM services charges automatically uploaded directly into your EHR, ready for submission.
Our experienced support team makes starting a new remote patient monitoring program easy. Withings Health Solutions handles all of the onboarding and managing support, so your care teams can focus on what matters most, providing high-quality care to patients.
Learn more about Withings Health Solutions for remote patient monitoring.
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This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.
When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.
On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.
Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).
Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.
“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”
Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C.
“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”
If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”
Interested in partnering with us?
Contact Us
[post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
[post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations.
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Withings products not only help individuals and their clinicians better monitor and understand health, but they are contributing to a wide body of research. Withings is honored that researchers are increasingly turning to our products across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption.
Here’s just a sampling of the diversity and reach of Withings products in medical research this year.
An October 2024 article in Frontiers in Neuroanatomy looks at the history and technical development of electrochemical skin conductance (ESC), as measured by Withings’ Sudoscan, and compares it to other measures of skin conductance such as galvanic skin response (GSR) and electrodermal activity (EDA). ESC was developed specifically to diagnose sudomotor function as opposed to GSR/EDA which is a continuous monitoring tool. EDA is increasingly incorporated into wearable technology. While both use skin/sweat conductance, it is important to differentiate EDA which can be used for physiological and psychological measures of stress from ESC which is used to evaluate sudomotor function and diagnose neuropathy. Withings has incorporated ESC in its smart scales which show a near perfect correlation with the Sudoscan clinical device. The Withings smart scales allow for easier and more frequent individual time series data as well as large scale data collection.
Public health surveillance has largely relied on self-reported surveys. This study applied mobile and wearable technologies to collect objective, real-time, continuous health data. Data from a variety of Withings products (Withings Sleep, Withings BPM Connect, Withings Thermo, and Withings Body+), were used to predict stress. Findings showed that a system, such as the Mobile Health Platform used here, could complement self-reported health data to better monitor and predict stress in a population.
This study compared the 1-lead ECG intervals available via the Withings ScanWatch with the standard 12-lead ECGs in children and adolescents. Smart watch intervals have previously been shown to be accurate for adults. The heart rate measure was found to be reliable for children, The automated QTc interval was less reliable but can be improved with manual measurements. It is worth noting that the study used pediatric subjects rather than adapting adult research, as is often the case.
This study of 67,254 adults showed that 30% of adults do not get the recommended 7-9 hours of sleep per night, and that even those who did average 7-9 hours, 40% of the nights fell outside the range. Only 15% of participants slept 7-9 hours for at least 5 nights per week. In addition to the findings of irregular sleep, the study highlights the usefulness of the at home Withings Sleep for large-scale and/or longitudinal sleep studies.
As we close out a year of significant knowledge advancements, we look forward to seeing what the global healthcare research community has in store for 2025.
If you are conducting research that might benefit from Withings technology, please contact us at contact-pro@withings.com.
Interested in partnering with us?
Contact Us
[post_title] => Withings 2024 Year in Review: Research Highlights
[post_excerpt] => 2024 was an exciting year for Withings. We’re honored that the global research community is increasingly turning to our solutions for studies across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption.
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Several new, large-scale studies1, 2, 3, 4 from the Flinders Medical Research Institute (FHMRI) in Australia found studying sleep in real-world settings over multiple nights can greatly reduce the high 30% error rate of sleep apnea diagnosis from polysomnography (PSG), the traditional, single night, in hospital gold standard technique. Using Withings Sleep Analyzer, researchers were able to easily track multiple biomarkers for participants over time revealing large variability in sleep indicators from night to night.
Withings under-the-mattress sleep trackers have enabled researchers to study large groups over time. The FHMRI studies tracked 67,278 and 12,287 participants respectively over a total of 11 million nights, a feat not feasible with traditional polysomnography.
A key finding from the study of 12,000 users is the variability in the severity of Obstructive Sleep Apnea (OSA) from night to night. The variability of OSA, independent of severity, is associated with uncontrolled hypertension which is the leading cardiovascular risk factor. Sleep Analyzer also reveals other risks associated with hypertension, such as snoring, irregular waking and sleep hours, and duration of sleep.
Using the same hardware technology as Withings Sleep Analyzer, Sleep Rx is a noninvasive, at home device that users place under their mattresses to gather biomarkers such as heart rate, respiratory rate, snoring, sleep cycles, and the Withings Sleep Index, a measure of breathing events per hour, which can aid in the diagnosis of sleep apnea. Using this simple device for at least 14 nights gives a much clearer picture of sleep quality.
The multi-night Sleep Rx data can be used to predict the right patients at the right time for in hospital PSG. Better identification of patients who most need PSG will reduce overall spending on the costly tests and ease scheduling difficulties.
Sleep Rx offers an inexpensive, easy to use method to better target high risk cardiovascular patients, reduce the high error rate of sleep apnea diagnosis, and efficiently gather longitudinal, large-scale sleep data for a variety of chronic diseases. For more information about the Withings Sleep Rx, click here.
1 Lechat, Bastien et al. “Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea.” American journal of respiratory and critical care medicine vol. 205,5 (2022): 563-569. doi:10.1164/rccm.202107-1761OC
2 Lechat, Bastien et al. “High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension.” NPJ digital medicine vol. 6,1 57. 30 Mar. 2023, doi:10.1038/s41746-023-00801-2
3 Lechat, Bastien et al. “Regular snoring is associated with uncontrolled hypertension.” NPJ digital medicine vol. 7,1 38. 17 Feb. 2024, doi:10.1038/s41746-024-01026-7
4 Scott, Hannah et al. “Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample.” Hypertension (Dallas, Tex. : 1979) vol. 80,5 (2023): 1117-1126. doi:10.1161/HYPERTENSIONAHA.122.20513
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[post_title] => Sleep Apnea Data from Multiple Nights is Key to Predicting Hypertension and Cardiovascular Risk
[post_excerpt] => New large-scale, longitudinal studies show that monitoring sleep for at least 14 nights at home with a connected sleep tracking mat, can reduce the 30% high error rate of sleep apnea diagnosis from the usual single-night, in hospital polysomnography (PSG) technique. This technology can identify which patients most need expensive, intrusive, and difficult to access PSG. Longitudinal data also detects variability of Obstructive Sleep Apnea from night to night which is associated with hypertension
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This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.
When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.
On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.
Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).
Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.
“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”
Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C.
“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”
If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”
Interested in partnering with us?
Contact Us
[post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
[post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations.
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Article
Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
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