Remote patient monitoring (RPM) is the new standard of care for high-risk/chronic patients. With medical devices that automatically send patient readings to the practice, providers can continue to monitor patient health and intervene when necessary, ultimately improving health outcomes and patient satisfaction.
Healthcare providers who implement remote patient monitoring are reimbursed for services with CPT codes 99453, 99454, 99457, 99458 and/or 99091. CMS has updated the RPM CPT codes this year. In order to bill for your RPM services correctly and optimize your reimbursement, it’s important to know these updates.
For 2022, we’ve compiled a list of the top three changes to RPM CPT codes that you need to know.
1. Communication requirements have been specified
CPT code 99457 is a monthly reimbursement for the first 20 minutes that a qualified health professional or clinical staff member checks readings, speaks with a patient, coordinates treatment plans and/or develops educational materials. For 2022, CMS has clarified that the provider and patient must have at least two-way, real-time interactive communication in order to bill for this code.
If your clinical staff does not have the time or resources to fulfill this interactive communication requirement, you can work with a partner that will perform these RPM services for you—and can still bill for this code and CPT code 99458, according to CMS. That being said, your billing practitioner must be available to aid the outsourced staff as needed.
Learn more about the benefits of outsourcing your RPM services through PatientPoint® here.
2. RTM CPT codes have been added
CMS has added remote therapeutic monitoring (RTM) codes for the first time: 98975, 98976, 98977, 98980 and 98981. You can bill for these codes if your practice is remotely monitoring patients without any physiologic data being involved.
If you’re tracking a patient’s physiologic data, bill for an RPM code. If you’re tracking non-physiologic data, whether it’s to check on respiratory conditions or ensure a patient is taking their medicine, bill for an RTM code.
Another major difference between RPM and RTM codes is how the data is reported. To be able to reimburse for RPM services, a device must automatically send the patient data to the billing practitioner. However, for RTM services, patients can report data themselves and provide it to the billing practitioner.
3. CCM rates have increased
CMS has boosted the national payment rates for chronic care management (CCM) this year. CPT code 99490 has increased by $22.86, while CPT codes 99439 and 99491 have grown by $10.76 and $3.65, respectively. Many of the Complex CCM and PCM codes also have higher rates in 2022, compared to 2021.
Another major update to CCM is that CMS has added a new code: CPT code 99437. This code accounts for the subsequent 30 minutes that a physician or nonphysician practitioner spends with a patient.
Since the CCM rates have gone up, it makes sense to bill for both RPM and CCM codes. Doing so will allow you to optimize your reimbursement and make it worthwhile to offer RPM services to your patients. Plus, you’ll be able to better accommodate your at-risk patients.