What is Remote Physiologic Monitoring?

RPM and Home Health Care Agencies

There has been a lot of talk about home health care agencies being able to bill Medicare for RPM services starting in 2019. It is Assured Medical's option that agencies will not be able to bill using these codes. Instead, agencies will be able to include the cost of providing RPM/telehealth as on operating expense on their annual cost report which will impact their cost per visit. Here at AMA, we see the following benefits of doing this:
  • Agencies should be able to include the following as telehealth expenses
    • Software purchased during that fiscal year for use with their telehealth program
    • Implementation fees paid during that fiscal year for starting their telehealth program
    • Telehealth equipment purchase or rental expenses
    • In-home installation and patient training expenses
    • The allocated portion of a telemonitoring nurse's salary
    • Additional expenses incurred in delivering telehealth services such as cell phone, internet, laptop for the telemonitoring nurse since these services can be provided remotely
  • The cost of a telehealth program will be spread across all patients, just not the ones being monitored
  • Will reduce the amount of effort required to bill telehealth per patient

See the CMS Changes for 2019 link under Additional Resources for the 682 page document from Medicare that talks about telehealth on the cost report. This information starts on page 313.

RPM and Physicians

Assured Medical Alliance has been providing remote monitoring equipment and services since 2012 and the number one question we get is "Is this reimbursed?" Well now we have a good answer - "YES!" This page provides information about billing codes that can be used when monitoring a patient.

In 2018, Medicare allowed for physicians to bill for RPM services using CPT code 99091. This code was "unbundled" which means that it is a separately payable service (does not need to be combined with another code).
CPT CodeDescription
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 health care professional, qualified by education, training, licensure/regulation"
  • Must be performed by physician, NP, PA, Certified Nurse Midwives, Clinical Nurse Specialists
  • Requires a minimum of 30 minutes of time reviewing, interpreting, responding to the RPM data and communicating with patient/family/caregiver
  • Can be billed every 30 days
  • Obtain consent prior to initiating RPM services, document in the patient's medical record
  • For established patients only. Must have seen patient face-to-face within last year.
  • Ruralness is not required to use this code
  • Can be billed along with Chronic Care Management, Transitional Care Management and Behavioral Health integration codes which can recoup time and cost of clinical staff triaging readings and ensuring reading compliance

Starting January 1, 2019, Medicare allows providers to bill for the use of telehealth equipment to more effectively and efficiently use RPM technology to monitor and manage patient care.

The 3 new CPT codes related to Remote Physiologic Monitoring are:
CPT CodeDescription
99453
  • Used to bill for the installation and training of the patient on the telehealth equipment.
  • This can be billed once per patient
  • No physician work required to bill
  • Can be billed with 99091 and 99457
99454
  • Used to bill for the equipment supply.
  • Can be billed every 30 days per patient
  • No physician work required to bill
  • Can be billed with 99091 and 99457
99457
  • Used to bill for time spent by clinical staff/physician/other qualified health care professional managing care of patient by utilizing the data collected from the telehealth equipment.
  • Can be billed every month (not 30 days) per patient
  • Don't bill if patient only on monitoring services for less than 16 days
  • Minimum of 20 minutes or more per month of interactive communication with patient/caregiver
  • Cannot be furnished by auxiliary personnel incident to a practitioner's professional services
  • Does not require patient to be in a rural area since RPM is not considered a Medicare telehealth service
  • Does not require the use of interactive audio-video
  • Requires a face-to-face visit in the previous 12 months prior to billing for RPM services
  • Obtain consent prior to initiating RPM services, document in the patient's medical record
  • Requires a co-payment because it is a Medicare Part-B service
  • Can be billed with Chronic Care Management codes (99490) if amount of time spent interacting with patient/caregiver is at least 40 minutes per month
  • Cannot be billed with 99091

There are several additional codes that can be used when seeking reimbursement from Medicare. The table below shows the CPT Code and a brief description:
CPT CodeDescription
99487, 99489, 99490 Chronic Care Management (CCM)
  • Nurses and ancillary staff can perform data analysis and patient communication but needed to have physician in office while work was being done.
  • Requires 20 minutes per month of interaction with patient
  • Patient must have two or more chronic conditions
  • Conditions are expected to last at least 12 months or until death of the patient
  • Conditions place the patient at significant risk of death, acute exacerbation, decompensation or functional decline
  • Physician must obtain patient consent
  • Must use Medicare certified EHR
  • Patient must have access to care management services 24/7
99491 New code for 2019 that allows for physician to bill in addition to the office staff doing 99490. May require 30 minutes of physicians time versus just 20 minutes as required by 99490.
G2012 initially called GVCI1
  • Virtual Check-Ins: Brief Communication Technology-Based Service
  • A 5-10 minute conversation with the patient “…To assess whether the patient’s condition necessitates an office visit…”
  • Telephone calls are allowed only by the billing provider (clinical staff can't bill)
  • A telephone call that is enhanced with video or other kind of data transmission is also allowed
  • Must be an established patient that has not had a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment
  • Used by physicians or other qualified health care professional who can report evaluation and management services
  • Requires collecting co-payment and patient consent for virtual check in
  • No frequency limits, location restrictions or special documentation requirements (document just like office visit)
99451 and 99452 Interprofessional telephone/Internet/EHR assessment and management service provided by a consulting physician. 5 or 30 minutes are required.
While this code is not specifically an RPM code, it can be used by physician when reviewing RPM data and making medication change.