Remote Patient Monitoring (RPM)
A Brief Definition
Remote patient monitoring, or RPM for short, means the use of physiologic readings data from a device to both monitor and manage a patient’s care remotely. There are many different types of devices that can be used, depending on the patient’s condition(s). Blood glucose monitors, blood pressure monitors, scales, pulse oximeters are the most common. However, for a device to qualify, it must be defined as a medical device under section 201(h) of the Food, Drug and Cosmetic Act. In addition, the data coming from the devices must be collected and transmitted electronically as opposed to self-reported by the patient.
Description of 2021 RPM CPT Codes & Reimbursement Rates
In 2018, CMS introduced CPT codes to reimburse providers for delivering RPM services to patients. The RPM reimbursement codes are similar to the Chronic Care Management (CCM) codes, but add device data collection and review to the requirements. Here is a breakdown of the RPM CPT codes and reimbursements currently available:
What Changes Did CMS Make in 2021 to Remote Patient Monitoring?
CMS continued to fine-tune the specifics in 2021. Below are a few of the more substantive changes to the RPM program and reimbursements from the 2021 Final Rule. However, you can review the details on all the changes in 2021 on this CMS fact sheet.
Clarification of the COVID-19 Two Measurement-Day Waiver – CMS clarified that this waiver only applies to patients that have either suspected and/or confirmed cased of COVID-19. For all other patients, the 16 measurement days would apply.
Established Permanent Policy for Delivery of Services by Auxiliary Personnel – For CPT codes 99453 & 99454, CMS permanently approved that auxiliary personnel may provide services under indirect supervision of a physician. Auxiliary personnel is defined by CMS as “… any individual who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician.”
Expanded Coverage to Acute Conditions – CMS clarified that RPM services may also be delivered to patients with acute conditions, in addition to those with chronic conditions.
Clarified Definition of Interactive Communication – CMS clarified that at least some of the time spent with towards CPT Codes 99457 & 99458 must include care management services and real-time interactions.
Data & Device Requirements – The final rule states that devices must meet the definition of a medical device as defined by the Food, Drug and Cosmetic Act, and that the data from those devices must be collected and transmitted electronically, i.e., no patient reported data is allowed.
Have questions about remote patient monitoring reimbursements, or want to learn how you can get help scaling your RPM program without any out-of-pocket expense?
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