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HomeHealth & FitnessHow do CPT codes work for Remote Patient Monitoring (RPM) Software?

How do CPT codes work for Remote Patient Monitoring (RPM) Software?

With remote patient monitoring , medical professionals can manage patients with chronic conditions from the comfort of their own homes. Healthcare providers use Medical CPT Code to document the medical services and treatments they provide to patients.

CPT codes are heavily used in medical billing. These codes specify the kind of treatment or care provided. CPT codes exist for practically anything a certified medical provider can do, and new ones are added every year. The Current Procedural Terminology (CPT) codes are assigned to every task and service a healthcare provider provides to a patient, including medical, surgical, and diagnostic procedures. A practitioner’s reimbursement from an insurer is based on these codes.

A CPT code is a five-digit numerical code without a decimal mark, but some codes have one letter and four numbers. Healthcare providers assign these codes to each task and service they provide. Each of them is associated with a different action and is used to bill and track medical services.

Purpose of Current Procedural Terminology codes

Healthcare companies use Current Procedural Terminology codes to determine the amount they will pay for surgical, medical, and diagnostic services.

To ensure uniformity, CPT codes are the same everywhere. The use of some may be frequent, while the use of others may be infrequent. 99214 and 99213, for example, are codes for general checkups.

Remote patient monitoring CPT codes are commonly used to incentivize clinicians. CPT 99453, CPT 99454, CPT 99457, CPT 99458, and CPT 9909 are some of the RPM billing codes. How do these codes work, and what are they? Let’s get started.

What is Reimbursement?

Your hospital, doctor, diagnostic facility, or other healthcare provider receives reimbursement for providing you with a medical service

Submitting a claim through the Centers for Medicare and Medicaid Services (CMS) can be a confusing and intimidating process. This is why we have made a small list of everything you would need to submit a claim through CMS: CPT codes for each program you manage for your patient, ICD-10 codes, care manager name, date of service, place of service, and provider name.

Remote patient monitoring (RPM) CPT codes have been established. RPM tracks patient vitals outside of the healthcare setting to allow providers to intervene and improve health outcomes.

RPM CPT Code: 99453

The RPM CPT Code: 99453 monitors physiologic parameters such as weight, blood pressure, pulse oximetry, and respiratory rate remotely. It represents the initial setup and patient education regarding the use of connected devices and when to take measurements. When a physician or qualified healthcare professional (QHP) recommends a patient enroll in a remote monitoring program, CPT code 99453 is used.

RPM CPT Code: 99454

The RPM CPT Code: 99454 covers the supply and provisioning of the device that is used by the patient, as well as the monthly remote monitoring of physiological parameters. A physician or qualified health professional must order the device. This CPT code is billed every 30 days and covers the cost incurred by the provider if they lease or purchase the device. This code requires the patient to submit device readings for at least 16 days during the 30-day period, as dictated by CMS in 2021. For technologies provided under CPT Code: 99454, the standard reimbursement is regardless of the cost of devices.

RPM CPT Code: 99457

The RPM CPT Code: 99454 is used for care coordination and management. RPM patients are required to receive 20 minutes of interactive virtual care each month from a qualified healthcare provider or care manager. No matter the patient’s conditions, this code must be billed once a month.

RPM CPT Code: 99458

This month’s interactive virtual care also includes RPM CPT Code: 99458. This code, however, is for additional time spent with the patient. In addition to billing in 20-minute increments using this code, healthcare organizations can use it once they meet the requirements for code 99457. A patient is billed for the incremental 20 minutes of virtual care if they receive 40 minutes through RPM.

Healthcare Common Procedure Coding System (HCPCS) codes are very similar to CPT codes, but not exactly the same. Codes for CPT are maintained, developed, and copyrighted by the American Medical Association (AMA). You can use a one-time CPT code designed for device reimbursement if you provide your patient with an RPM device. RPM programs can generate revenue as well as broaden patient access to care and prevent emergency situations. There is inherent value in the combination. You should better understand the new RPM codes, their specific amounts, and how you can use them if you have been considering transitioning to more remote care in the wake of Covid-19.

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