Disclaimer: This blog article was written by an AdvancedMD partner. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of AdvancedMD.
Medicare introduced reimbursement for RPM in 2019, making it no cost to most seniors with at least one chronic condition. Acknowledging the increased risks and challenges of medical office visits by seniors during the COVID-19 pandemic, CMS has recently made these notable changes:
- The decision to allow RPM to be furnished “incident to” under general supervision.
- The addition of CPT Code 99458, a new add-on code for patients who receive an additional 20 minutes of RPM services in a given month (i.e., 40 minutes of RPM service per patient rather than the previously allowed 20 minutes)
These changes have significantly expanded how healthcare providers can treat their patients using RPM. They can now treat their chronic care patients not only using traditional CCM codes, but they can provide a wider array of care options and spend more time on that care with the addition of CPT 99458.
Perhaps even more importantly, patient care provision is no longer limited to direct physician supervision where the physician must be physically present in the building at the time of care. Instead, auxiliary staff are now empowered to monitor patients’ data and escalate that information if it indicates a need for intervention even when the physician is off-site. Typically, physicians are the highest-paid employees in a practice, so enabling other staff members to perform RPM tasks increases the program’s return on investment while freeing up doctors’ time to focus on making the best healthcare decisions for their patients.
The financial impact of adding RPM for your practice
So how do the new changes work and what’s difference can they make to your bottom line each month? When a patient is initially set up for remote patient monitoring, you will be able to bill
once for CPT 99453. After the initial setup, you can provide remote patient monitoring services and bill using CPT Codes 99454, 99457, and 99458. CPT 99454 covers RPM device supply, data transmission, and programmed alerts and can be billed every 30 days.
When you provide 20 minutes of RPM care per patient per month using CPT 99457 and 99454, you can earn $114.05. For each additional 20 minutes you spend performing remote patient monitoring services for a patient, you may also bill for CPT 99458 (up to two times). If you provide 60 minutes of RPM care per patient per month using all three codes (CPT 99457, 99458 and 99454), you can earn a total of $198.49.
Typically, a practice will utilize a portion of these earnings to cover the RPM device costs and solution provider’s monthly service fee. When selecting an RPM provider, you’ll want to avoid those that require payment of upfront device costs or setup fees. In doing so, your practice can start seeing a profit within the first month of offering RPM services.
Learn how your practice can add incremental revenue through remote patient monitoring with the whitepaper The economics of Remote Patient Monitoring for your practice.