CPT Codes for Remote Patient Monitoring & What They Mean for Physicians
This is BIG. Like, the biggest change to digital health and physician financial incentives, big. As of January 1, 2019, CMS went live with 3 new CPT billing codes (99453, 99454, 99457) for better remote patient monitoring (RPM). This landmark change opens up the use of innovative RMP technologies to increase physician reach and improve patient care.
So, what are the new CPT codes?
“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.”
“Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” Pays about $65-$69 per patient, per month.
“Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
There is a massive opportunity for reimbursement within remote patient monitoring! The average physician with a patient panel size of 2000 could add approximately $390,000 in additional billable revenue.
How are the new CPT codes different from 99091?
Before the introduction of these new CCRPM codes, physicians wishing to bill for remote patient monitoring used a 17-year-old CPT code, 99091. This code (although updated in 2018) didn’t reflect how patient health data is collected and imposed challenging restrictions.
The Old CPT 99091 required:
1) Patient set-up to be carried out in-person
2) Practitioners to spend 30 minutes per 30 days engaging with RPM data
3) Technology implementation and review to be done my physicians and select health professionals (not general clinic staff)
4) Payment under Medicare with physician fee schedules (could not be billed by HHAs, etc.)
The new PRM codes (99453, 99454, 99457) set you up for success
These new codes still come with requirements for billing. However, the reimbursement potential is much greater and more reflective of the current healthcare landscape and staffing. For example, HHAs and clinical staff are now included in the model and there’s incentive to implement innovative, third-party technology (like PeerWell).
Here are some requirements for billing:
CPT code 99454 pays the most, at approximately $69 per patient, per month. This code allows for separate billing for a technology set-up reimbursement.
As a Physician, Here’s Why You Should Take Advantage:
New codes could generate $390,000+ in additional revenue per year (based on a patient panel size of 2000, if 25% of these patients are with Medicare and activate with choice RPM technology).
RPM technology lowers patient risk/ flags those who require additional support, prevents complications/ worsening conditions, reduces readmissions, offers greater at-home care (lowering hospital/ clinical admittance)
Minimizes patient costs when complications are reduced and readmissions are avoided
You can offer patients modern, individually-tailored healthcare that is not just reactive, but is empowering and preventative in nature.
Extends your clinical reach to keep patients on track, while offering unprecedented access into valuable patient data and health tracking.
Why PeerWell as Your Choice RPM Technology?
No major set-up required
PeerWell’s surgery optimization & avoidance programs use the patient’s existing smartphone or device. No additional technology is required and setup is under 5 minutes.
Lowers patients risk
Daily patient programming is customized, lowering individual risk and improving key health metrics via the 5 pillars at home.
Patients go home after surgery
Proven at-home program for surgery preparation, pain management and post-op recovery. In fact, a recent study found that 77.2% of PeerWell TKA patients discharged home without any medical assistance (compared to an average of 42.5%).
Captures data for easy review
Electronically recorded consent is captured and data is seamlessly synced to clinic desktops for easy monitoring and review.