CPT Code 99453 is the setup code for Remote Patient Monitoring and reimburses physicians for the time it takes to help patients set up and learn how to use their devices.
What is Remote Patient Monitoring?
Remote Patient Monitoring (CPT 99454, 99457 & 99458) involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition. In order to provide services, patients must have both a device that gathers physiologic data–like a blood pressure cuff or blood oxygen monitor–and a device that transmits that information to their physician.
What Services are Required?
Medicare guidelines specify the following for CPT 99453: “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
Medicare simply requires that someone under the supervision of the physician (clinical or auxiliary staff) spend an unspecified amount of time helping the patient to set up and become familiar with their devices.
Medicare patients with acute and/or chronic conditions that would benefit from consistent monitoring qualify for remote patient monitoring. Providers must ensure that patients meet the following requirements before commencing services:
- Both new and established patients can receive RPM services during the public health emergency of Covid-19. But, once the emergency ends, RPM services will only be for established patients
- Consent obtained and documented by provider or by those providing RPM services under contract to provider at or before the time services are provided
- New patients or patients not seen by the practitioner within the last 12 months must be inducted into the program by a face to face initiating visit
- Only physicians and NPPs who are eligible to furnish E/M services may bill RPM services
What Devices Are Used for CPT Code 99453?
There are two major categories of devices used for remote patient monitoring.
The first category includes the devices that directly measure patient physiologic data. These devices must be FDA-recognized medical devices and could include:
- Blood Pressure Cuff
- Pulse Oximeter
- Heart Rate Monitor
- Weight Scale
- Respiratory Flow Rate Monitor
The second type of device is the one that transmits the collected information to the provider. There are many options on the market, most of which connect via Bluetooth® to the measurement device and via Wi-Fi and/or cellular data to the provider’s portal.
A recent study of diabetes patients concluded that one of the biggest factors in patient openness and adoption of RPM is whether the transmission device is unobtrusive and easy to use. Many patients are already accustomed to using some of the monitoring devices in their daily lives but will have to get used to paring with a transmission device. It must be easy to set up and fairly hands off in daily usage.
Does CPT Code 99453 Cover the Device Cost?
No, CPT Code 99453 only covers the cost of time spent educating the patient on device set up and usage. Medicare does not reimburse providers for the initial cost of buying or shipping RPM devices.
This reimbursement gap has proved to be a hurdle for many providers in starting an RPM program. The upfront time and expense of identifying measurement devices, researching and procuring the best transmission devices and supplying them to the patient are significant. For this reason, it may be best for providers to partner with a third-party supplier and services company that can provide cost effective solutions.
How Much Does Medicare Reimburse?
As of 2023, the average reimbursement for CPT Code 99453 (non-facility RPM setup) was $19.32.
How Often Can You Bill for CPT Code 99453?
This code is an initial code and can only be billed once per patient at the start of services. Monthly codes CPT Codes 99454 and 99457 cover the monthly ongoing servicing costs for device supply and treatment services.
Can a Third Party Deliver Services on Behalf of the Practice?
Yes, under a provider’s general supervision, a third party remote patient monitoring partner can provide education on device activation and use. Leveraging a third-party partner with focused expertise in RPM can alleviate the logistical challenges associated with this highly valuable service.
Getting Help with Remote Patient Monitoring Services
HealthXL® delivers easily implemented Remote Patient Monitoring and Chronic Care Management Services to improve care for Medicare patients with chronic and acute conditions. By combining consistent virtual monitoring, follow-up and accountability, our services are proven to improve patient care, streamline the healthcare process and boost practice revenue. Contact us today to find out more.