Remote Patient Monitoring Reimbursement Requirements
Updated: Sep 29, 2022
The Centers for Medicare & Medicaid Services (CMS) decided to reimburse providers as a monthly fee for remote patient monitoring (RPM) billed under CPT code 99091. The services are defined as “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 (when applicable) requiring a minimum of 30 minutes of time.”
This is good news for providers and telehealth firms looking to give patients alternative treatment methods. RPM services involve the interpretation of medical information without direct interaction between the practitioner and beneficiary. This means that Medicare pays for RPM services as if they were in-person physician services. In fact, the patient can even receive RPM services in the home.
CMS Requirements
While the 99091 code does not fully describe the way RPM services are furnished, providers, CMS and patients did not want to wait for the development of new codes. CPT 99091 is not a newly created code. It was unbundled to a service that is separately payable.
Below are some core requirements needed to bill Medicare for RPM services under this code:
The patient must consent to RPM services and the practitioner must document it in the patient’s medical record.
CPT 99091 should only be reported once in a 30-day period.
For new patients or patients not seen by the practitioner within one year prior to billing RPM, the practitioner must conduct a face-to-face visit with the patient. E/M service level CPT codes 99212 to 99215 should qualify for this visit as well as an Annual Wellness Visit or Initial Preventive Physical Exam.
Physician and other qualified healthcare professional time must be included in the service.
The patient can be at his/her home because RPM services are not thought of as telehealth services under Medicare.
New Billing Opportunities
This area appears to have a potential for an upside for those providing RPM technologies. RPM services billing opportunities can drive renewable revenues while improving the patient care experience.