Implementation of remote patient monitoring can be easy, but getting paid for your work is also critically important. CMS, along with some private payers, has expanded reimbursement opportunities for remote patient monitoring. The transition from fee-for-service to value-based-care has changed the landscape for how providers care for their patients. With value-based care, it’s more important to be proactive in keeping your patients healthy, therefore CMS has expanded reimbursement codes to fit this model. Here are several commonly used codes:
Device management/training/implementation – These codes account for professional service, clinical staff time, and practice expenses.
CPT Code 99453 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.
CPT Code 99454 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
CPT Code 99457 – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
CPT Code 99458 – Same as 99457, but for an additional 20 minutes or more of clinical staff/physician/other qualified healthcare professional time.
Reference to codes
Important Update: CPT Codes 99457 and 99458 no longer require the full 20 minutes to include interactive communication. It can be split between interactive communication with the patient and care management services.
CPT Code 99091 – 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 qualifed health care professional, qualifed by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days).
PCM (Principal Care Management)
CPT Code G2064 – Comprehensive care management services for a single high-risk disease, e.g. Principal Care Management, at least 30 minutes of physician or other qualified health care professional time per calendar month.
CPT Code G2065 – Comprehensive care management for a single high-risk disease services [sic], e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
Reference to PCM codes
TCM (Transitional Care Management)
CPT Code 99495 – Communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of at least moderate complexity and a face-to-face visit within 14 days of discharge.
CPT Code 99496 – Communication with the patient or caregiver within two business days of discharge. This can be done by phone, e-mail, or in person. It involves medical decision making of high complexity and a face-to-face visit within seven days of discharge.
Reference to TCM codes
Virtual Check In – Virtual check in support
HCPCS G2012 – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualifed health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
Reference to Check-In code