Medicare

Patient must suffer from at least one qualifying condition, have been seen for a face-to-face visit within the last 12 months, and express a willingness and ability to participate in remote monitoring

Qualifying conditions for remote monitoring:

• Diabetes
• Hypertension
• High-risk Pregnancy
• COPD
• CHF

Medicare Billing

Medicare CPT codes for Remote Patient Monitoring:

CPT Code 99453 - Patient education and setup: “Initially sets parameters on remote monitoring in regards to measuring weight, blood pressure, pulse oximetry and respiratory flow rate, as well as guidelines on patient education surrounding such equipment.” (Showing the patient how to set-up and use devices) $21 one-time fee

CPT Code 99454 – Device and Data Supply: “Focuses on the devices themselves and sets guidelines around daily recordings and programmed alerts. Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” $69 billed per 30 days of care

CPT Code 99457 - Initial 20 Minutes of Monitoring: "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. These services may be furnished by auxiliary personnel incident to a practitioner's professional service.” $54 per 30 days

CPT Code 99458 – Additional 20 Minutes of Monitoring: “add-on code for patients who receive an additional 20 minutes of RPM services in a given month (i.e., 40 minutes of RPM services).” $42 per 30 days (There is no limit to the number of times this can be billed in a calendar month.)

Medicaid

The Division of Medicaid covers remote patient monitoring for a patient meeting the following criteria:

• Has been diagnosed with one (1) or more of the following chronic conditions of diabetes, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD)
• Has had two (2) or more hospitalizations in the previous twelve (12) months for one (1) of the chronic conditions listed above.
• Hospitalizations for two (2) different chronic conditions cannot be combined to satisfy the two (2) or more hospitalizations requirement.
• Patient is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data.

References

• Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019
• Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule
• Mississippi Medicaid Remote Patient Monitoring Conditions
• Administrative Code, Title 23: Medicaid, Telemedicine
• Remote Patient Monitoring: Medicare Proposes Two Major Expansions
• What do rising chronic disease rates mean for Mississippi?
• Remote Patient Monitoring: A Mississippi Success Story