In recent years, remote patient monitoring (RPM) programs have been developed rapidly. The COVID-19 pandemic, coupled with technological progress and the increasing adoption by doctors and patients, has further boosted demand. In response, Centers for Medicare and Medicaid Services (CMS) activated multiple reimbursement codes for remote monitoring of coverage and payment. CPT code 99453 is the setting code for remote patient monitoring and compensates the time spent by doctors to help patients set up and learn how to use the equipment.
CPT code 99453 and CPT code 99454 reimburse and provide expenses related to remote monitoring services for collecting remote physiological parameters (e.g., body weight, blood pressure, pulse oxygen saturation, respiratory flow rate). This includes the costs associated with the monitoring device and the cost of distributing the device to the patient.
CPT code 99453 is a one-time reimbursement code related to settings. And this means taking into account the efforts made to educate patients about the equipment they will use to monitor their specific condition. Please note that it can only be used once. No matter how many remote monitoring devices a patient uses or how many discrete providers take care of the patient, CPT code 99453 can only be charged once in each care of each patient.
CPT code 99454 relates to the supply of device for monitoring, which must be ordered by the patient's doctor or other qualified healthcare providers. In addition, the device must be defined by the FDA as a medical device.
Unlike CPT code 99453, CPT code 99454 can be used multiple times. In fact, 99454 can be reported every 30 days. However, 99454 can only be billed by one practitioner, and each patient can only be billed once every 30 days, regardless of the number of devices used. In other words, even if a patient uses a weight meter, blood pressure monitor, and pulse oximeter, the CPT code 99454 may only charge the patient once every 30 days.
There are many devices on the market that can meet the needs of various RPM programs. As far as CPT code 99453 is concerned, they all have the same purpose of generating and wirelessly transmitting patient physiological data. However, each of these devices may have different functions. When choosing RPM solutions, it is important to find technology providers that provide support and training. Specialized support managers can show and teach the complexity and nuances of the device to specialized clinical staff in your office, who will eventually distribute the equipment to patients.