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CPT Codes
In recent years, the American Medical Association has increased their support and enablement of RPM by adding a number of new or amended CPT codes for use by a variety of healthcare providers. These codes provide coverage and payment in support of remote patient monitoring (RPM) services you provide.
The codes and code descriptions are listed for your reference.
99091
Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
Can be billed each 30 days.
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.
Can be billed once per episode of care.
99454
Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
Can be billed each 30 days, minimum 16 days of monitoring.
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
Can be billed every 30 days. The 20 minutes of professional time must occur in a calendar month.
99458
CMS announced this new add-on code (covered effective January 1, 2020) is for each additional 20 minutes of service.
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.
Can be billed each 30 days.
According to CMS, accredited and recognized DSMT programs may offer and bill for DSMT telehealth services regardless of the provider type — including Registered Nurses (RNs).
Please review this telehealth resource from ADCES for more details.
98966
Telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
98967
Telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.
98968
Telephone assessment and management service provided by a qualified nonphysician healthcare professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.
As you probably know, getting reimbursement can be unpredictable, to say the least. Tidepool is sharing this info to help you understand the CPT codes that exist. It doesn’t guarantee that you’ll get reimbursed. You should always check with the applicable payer to understand their policies and requirements.
