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The Centers for Medicare and Medicaid Services (CMS) can guide the interim final rule (IFR) of "policy and regulatory revision of medical insurance and Medicaid plan in response to COVID-19 public health emergencies", which allows remote patient monitoring. This type of patient care is very helpful for continuous treatment during the COVID-19 pandemic because it allows clinicians to remotely monitor temperature and lung function, blood pressure, and other appropriate physiological conditions with digital connections and noninvasive devices (such as temperature sensors or thermometers, pulse oximeters, and home blood pressure monitors) to understand changes in patient disease and symptom progression.

1. Introduction to CPT code 99453

Some RPM devices are equipped with a cellular blood pressure monitor, cellular weight scale, and wireless pulse oximeter, which can accurately measure blood oxygen level, pulse rate, and perfusion index. At first, it is created to help monitor patients with chronic diseases, RPM has a specific current program terminology (CPT) code.

CPT code for providing RPM includes:

CPT code 99453: remote monitoring of physiological parameters (such as body weight, blood pressure, pulse oxygen saturation, respiratory flow rate), as well as initial settings of device use and patient education. (including the initial setting of monitoring device and patient education; if the monitoring time is less than 16 days, please do not report CPT code 99453)

CPT code 99454: the device provides daily recording or programmed alarm transmission every 30 days. (provide initial collection, transmission, and report/summary services to clinicians managing patients)

CPT code 99457: remote physiological monitoring treatment management service, clinical personnel/doctors/other qualified medical and health care professionals need to interact with patients/nursing staff within one month, especially in the first 20 minutes.

CPT code 99458: each additional 20 minutes (listed separately except for the code of the main program.)

CPT code 99091: collect and interpret physiological data (e.g., electrocardiogram, blood pressure, blood glucose monitoring), store and transmit them digitally by patients or nursing personnel to doctors or other qualified health care professionals who have been certified by education, training, license, or regulation (when applicable), and it takes at least 30 minutes every 30 days.

2. The use of CPT code 99453

When the code has a description that contains "time", it is a red flag and reminds you to ensure that the provider documentation has included the component in the access record (logged). CMS does provide reimbursement for CPT code 99453 for initial setup and patient education on how to use monitoring device. Reimbursement is also provided for CPT code 99454 to provide device within 30 days.

Please note that according to the IFR on April 30, CMS will allow the time to report the remote physiological monitoring service to Medicare during a public health emergency (PHE) to be less than 16 days, but not less than 2 days. For monitoring for less than 16 days but more than two days, the payment of CPT codes 99453, 99454, 99091, 99457, and 99458 is limited to patients with suspected or confirmed COVID-19.

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