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Remote monitoring helps healthcare professionals understand how the patient is progressing during recovery and helps the patient access and receive better care at a lower cost. The largest benefit is the increased volume and timeliness of information available to healthcare professionals and patients, which can help with medical discussions and decisions. Example:   A total knee arthroplasty (TKA) patient who is walking with difficulty at three weeks after surgery but had a good two-week follow-up visit may benefit from changing their physical therapy program. With remote monitoring, the healthcare professional and patient can see there is a need to change the care plan and intervene before the scheduled six-week follow-up visit. Current procedural terminology (CPT^®) codes for Remote Patient Monitoring (RPM), also known as Remote Physiological Monitoring, were established in 2019 for use beginning in 2020. Definition:  RPM is the collection of physiologic data digitally stored and/or transmitted by the patient or caregiver or both. Key Considerations:

• The medical device must be cleared by the Food and Drug Administration (FDA).
• Data must be digitally and automatically recorded and uploaded to the secure location where the data can be available for analysis and interpretation by the billing practitioner.
• Patient consent must be obtained at the time the remote monitoring services are furnished.
• There must be an established patient-physician relationship.
• Physicians and Qualified Health Professionals who are eligible to provide Evaluation and Management services may order and bill RPM services.
• The services may be provided by auxiliary personnel under the general supervision of the billing practitioner.
• RPM data must be collected for at least 16 days out of 30 days.
• RPM monitoring services must monitor an acute care or chronic condition.

RPM CPT CODE	Description	Requirements	2023 CMS Monthly Payment*
99453	Practice expense code. Setup. Service Initiation / Patient Education. Billed one time per patient.	Patient consent to participate; Base station transmitting data.	$16 – $27
99454	Practice expense code for collection of remote monitoring data. Billed once each 30 days.	Data must be automatically collected/transmitted for a minimum of 16 of the 30 days.	$42 – $70
99457	Professional code. Care / treatment management. Remote monitoring treatment management services, first 20 minutes of qualified HCP time in a calendar month. Billed once per month.	Interactive communication between the patient and HCP is required. Total time, including data review, discussion, physician review, scheduling, is at least 20 minutes.	$44 – $61
99458	Professional code. Care / treatment management. Remote monitoring treatment management services, each additional 20 minutes of qualified HCP time in a calendar month. Billed up to 2x per month after 99457.	Interactive communication between the patient and HCP is required. Total time, including data review, discussion, physician review, scheduling, is at least 40 minutes (first billing) or 60 minutes (2nd billing).	$36 – $51

*Note, the Centers for Medicare and Medicaid update the physician fee schedule quarterly and fees vary depending on location, cost of living and quality measure reporting. To find local payment information, go to https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched. Values shown in this chart are sourced from the January 2023 update to the physician fee schedule, accessed March 30, 2023. Billing for private insurance: Check with the patient’s insurance company for information on their billing and reimbursement policies. Depending on the patient’s insurance, they may have a copay. Billing for Medicaid: Each state has its own remote patient monitoring billing and reimbursement policies. Healthcare Professionals can check their state’s policies at the National Policy Center – Center for Connected Health Policy at https://www.cchpca.org/topic/remote-patient-monitoring/. Disclaimer: The summary information contained herein is for information purposes only and, in all instances, is subject to the specific requirements set forth in applicable laws and regulations. Nothing herein is intended to, or shall, constitute medical advice. Each healthcare professional must use his or her own medical judgment and expertise with respect to all decisions pertaining to medical treatment and/or care of patients under his or her care. CPT is a registered trademark of the American Medical Association. Additional Resources: https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring, accessed May 31, 2023.