The RPM Revolution Begins!

Posted on 29 Oct, 2018 |comments_icon 0|By Bruce Pegg

In part one of this series, we looked at several new 2019 CPT® codes that will enable you to capture payment for telehealth services. In this second blog, we’re going to look at another way telehealth is reshaping healthcare by changing the way providers monitor and manage patients with chronic diseases.

In our Oct. 5 post, we briefly introduced you to three new codes that document remote physiologic (or patient) monitoring, better known by its acronym RPM. These are codes you can use whenever you bill for times when your provider monitors a patient who is receiving either chronic care management, transitional care management, or behavioral health integration services.

Now, we’re going to get a little deeper into each one to see how you might use them. But first, we need to revisit an old code that may have flown under your radar. If it did, you need to rediscover it, because it has the potential to positively affect your bottom line.

Benefit from RPM Unbundling

If you’re an eagle-eyed coder, you may have noticed CPT® changed the wording of 99091 (Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time) on Jan. 1, 2018 to add the words “each 30 days” to the descriptor’s wording.

What you may not have realized at the time is that Medicare also unbundled 99091, making it separately payable from the other services mentioned above. Medicare currently reimburses nonfacility use of 99091 nationally at $58.68 every 30 days, which could make it a significant addition to your practice’s revenue stream.

Codes to Capture Connectivity

Now cut forward a year. CPT® has introduced additional codes to fully describe the process where data from a medical device, such as an echocardiogram, a blood glucose monitor, or a blood pressure cuff, is transmitted directly from the patient to the provider, often via a Bluetooth connection to the patient’s cell phone:

  • 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
  • 99454 — … device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
  • 99457 — Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

As the code descriptors state, each one delineates a step in the data collection process. Code 99453 describes device set up and patient education, while 99454 documents device supply and the daily recording of physiologic data, which you can report once every 30 days. Code 99091 will be used when your physician interprets the data. And you can use 99457 to report 20 minutes of communication per month between your provider and patient regarding any vital information or care plan revisions based on that interpretation.

There’s no word yet on whether Medicare will follow its earlier ruling on 99091 and make these new services separately payable as well. Watch this space and be among the first to know when they do!

When Telehealth Is Not Telehealth

One final note to remember about these RPM codes: even though they use telecommunication to transmit data, technically speaking, Medicare does not define them as telehealth services and they are not documented in the same way you would document other similar services. So, you won’t need to worry about providing documentation establishing the locations of the originating or remote site, and you won’t have to use modifiers such as place of service (POS) codes 02 (Telehealth) or 11 (Office), or even modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) to indicate they are telemedicine services.

Learn More

Master telemedicine coding, billing, and compliance with The Telemedicine & Telehealth Handbook for Medical Practices 2018. Learn telehealth fundamentals through practical examples, and nail down new telemedicine codes, rules for licensure, credentialing, reimbursement, and much more, including expert advice and a telehealth toolkit.

Stay on top of the latest code and guideline changes, as well as regulatory updates and revisions to CCI bundles, modifiers, payer policies, the physician fee schedule, the OIG work plan, TPE, RACs, and more with Medicare Compliance & Reimbursement.


Bruce Pegg
Editor, Newsletters

An experienced teacher and published author, Bruce is TCI’s new voice of primary care, delivering advice and insights every month for coders in the fields of family, internal, and pediatric medicine through Primary Care Coding Alert and Pediatric Coding Alert. Additionally, he is the current editor of E/M Coding Alert. Bruce has a Bachelor of Arts degree from Loughborough University in England and a Master of Arts degree from The College at Brockport, State University of New York. He recently became a Certified Professional Coder (CPC®), credentialed through AAPC.

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