Simply put, remote patient monitoring allows healthcare providers to monitor aspects of a patient’s health remotely via transmission of medical information from mobile devices. For example, blood glucose and blood pressure readings can be transmitted in order for this information to be tracked and flagged if it appears intervention is necessary. The transmission of this information in real time, on a regular basis allows for better management of chronic medical issues, resulting in fewer instances where high cost medical intervention such as hospitalizations, may be required. It has been noted that with the aging population and the corresponding burden on the healthcare system, along with the development of new and improved technologies, the use of remote patient monitoring will continue to grow. In short, benefits of RPM include better health outcomes, reduction in cost and greater access to healthcare.
Effective January 1, 2019, the American Medical Association (AMA) introduced three new remote patient monitoring CPT codes:
- 99453, Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment,
- 99454, Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days, and
- 99457, Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
These codes were added to the existing CPT code 99091, Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) 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/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.
The guidelines pertaining to these codes, as published in the CPT Codebook, include the following:
For the reporting of CPT codes 99453, 99454 the guidelines under the section “Digitally Stored Data Service/Remote Physiologic Monitoring,” specify that these CPT codes “are used to report remote physiological monitoring services (e.g., weight, blood pressure, pulse oximetry) during a 30-day period. To report 99453, 99454, the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional. Code 99453 may be used to report the set-up and patient education on use of the device(s). Code 99454 may be used to report supply of the device for daily recording or programmed alert transmissions. Codes 99453, 99454 are not reported if monitoring is less than 16 days. Do not report 99453, 99454 when these services are included in other codes for the duration of time of the physiological monitoring service.
Code 99453 is reported for each episode of care. For coding remote monitoring of physiologic parameters, an episode of care is defined as beginning when the remote monitoring physiologic service is initiated, and ends with attainment of targeted treatment goals.
CPT code 99091 should be reported no more than once in a 30-day period to include the physician or other qualified health care professional time involved with data accession, review and interpretation, modification of care plan as necessary (including communication to patient and/or caregiver), and associated documentation.”
The guidelines under the section “Remote Physiologic Monitoring Treatment Management Services,” which includes CPT code 99457 instructs the following: “Remote physiologic monitoring treatment management services are provided when clinical staff/physician/other qualified health care professional use the results of remote physiological monitoring to manage a patient under a specific treatment plan. To report remote physiological monitoring, the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional. Use 99457 for time spent managing care when patients or the practice do not meet the requirements to report more specific services. Code 99457 requires a live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month.”
Reference the CPT Codebook for the complete guidelines pertaining to these codes to ensure accurate reporting. In addition, watch for new and revised CPT codes for remote patient monitoring that will become effective on January 1, 2020.In conclusion, the growing availability of mobile apps and wearable devices allows the tracking of vital signs such as blood pressure, pulse and cardiac monitoring in real time. The result is lower healthcare costs with improved outcomes in a way that offers convenience to both the patient and provider.