Getting Paid for Your RPM Services

4 min read

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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