CPT 99453

REMOTE PATIENT MONITORING

Remote patient monitoring is the use of digital technologies for the gathering of health data from the patient in one location and also the electronic transmission of that data to a provider in a very different location for review and subsequent recommendations, particularly in patients with ongoing and/or chronic disease processes.

Remote patient monitoring (RPM) devices allow providers to observe, report, and analyze their patient’s acute or chronic conditions from outside the hospital or clinic setting. They permit real-time understanding of a patient’s disease state, enabling the provider to create proactive clinical decisions.

CODE DESCRIPTION

CPT 99453 includes remote monitoring of physiologic parameters, like weight, pressure level, pulse oximetry, respiratory rate. This code represents the initial setup and patient education on the way to use connected devices moreover as best practices on when to require measurements.

RPM Devices

Following are the some of the most commonly used RPM devices:

• Blood Pressure Cuff
• Glucometer
• Pulse Oximeter
• Heart Rate Monitor
• Respiratory Flow Rate Monitor
• Thermometer
• Weight Scale

CODING CRITERIA

For CPT 99453, providers must make sure that patients meet the subsequent requirements before commencing services:

• CPT 99453 is always billed with an E/M code.
• Both new and established patients can receive RPM services during the general public health emergency of Covid-19. However, once the emergency is over, RPM services will only be provided to established patients.
• Consent obtained and documented by those providing RPM Services under contract at or prior to the provision of Services.
• New patient, or patients who have not been seen by a physician in the last 12 months, should be enrolled in the program through an in-person visit.
• Providers may use this code during the same service period as Chronic Care Management (CCM) (99487-99490), Transitional Care Management (TCM) (99495-99496), and Behavioral Health Integration (BHI) (99484, 99492-99494).

BILLING CRITERIA

• CPT 99453 is valid only once per episode of clinical treatment.
• This is true even if the patient is being treated by multiple physicians or using different RPM devices.
• Only medical professionals and NPPs qualified to provide E/M services may bill RPM services.
• The monthly continuous servicing charges for device supply and treatment services are covered by CPT Codes 99454 and 99457.
• CPT code 99453 requires usage of a medical device that digitally collects and transmits 16 or more days of data every 30 days for the billing of this codes.
• Devices used must meet the FDA definition of a medical device.
• Data should be synced wirelessly where it can be evaluated.

REIMBURSEMENT CRITERIA

CPT code 99453 permits for a one-time reimbursement of $19.03.