New CMS Codes for Remote Patient Monitoring in 2019

New CPT Codes released by CMS in 2019 are meant to incentive providers to offer better quality Remote Patient Monitoring (RPM) services, especially for those patients diagnosed with chronic diseases. These rules also give healthcare providers greater leeway to collaborate with digital health companies to provide RPM services.

2019 RPM CPT Codes Explained

CPT 99453:  This code reimburses certain costs associated with initial device set-up and patient education on the use of devices such as blood pressure cuffs, pulse oximeters and even scales. This is necessary because patients may know how to use these devices on their own but they may not understand how to sync them to a device in order to transmit the data remotely. Reimbursement for this charge is minimal but overlooking it could cost your organization a one-time reimbursement of $21 per patient participating in a remote monitoring care plan.

CPT 99454: Allows for the reimbursement of remote monitoring of physiologic parameter(s). For example, weight, blood pressure, pulse oximetry and respiratory flow rate. This code is also meant to cover the initial supply and set-up of devices. CMS specifically noted these devices should be capable of “daily recording(s) or programmed alert(s) transmission, each 30 days.” However, most devices cannot function without a platform to help transmit the data. In addition, they may depend on software to help recognize abnormalities or declining health status and alert providers. CMS will reimburse approximately $69 per patient, per month.

CPT 99457: This code covers remote physiologic monitoring treatment management services. CMS requires 20 minutes or more of professional time from clinical staff, physicians or other qualified healthcare professionals, along with interactive communication with the patient or caregiver, each calendar month. The reimbursement for this service is approximately $59 per month.

Capturing Chronic Care Management Reimbursement

In addition to revenue generated by Remote Patient Monitoring, providing these services could be a catalyst to offering Chronic Care Management services under CPT codes 99490 and 99487 which allow for reimbursement of approximately $43 and $94 respectively. The difference is 99490 requires 20 minutes of Chronic Care Management and 99487 requires 60 minutes of Chronic Care Management. However, creating better patient engagement and acquiring a more robust and timely set of health data from Remote Patient Monitoring would help providers offer better Chronic Care Management services to their patients.

Requirements for Billing

Providers should note that there are additional requirements to bill for Remote Patient Monitoring. Three of the most important requirements are:

• Patients must be diagnosed with 2 or more chronic conditions
• The devices used to collect and transmit data must be cleared by the FDA
• RPM must be ordered by a qualified healthcare professional

An End-to-End Solution for RPM

HealthKOS™ has created an end-to-end solution that provides your organization with the tools needed to offer true remote patient management and capture the revenue generated by providing these enhanced services to your patients.

For more information on the HealthKOS Platform, or to request a demo, please contact us at 1-855-227-3567 or info@healthkos.com.