Reimbursement

The CMS has identified Remote Patient Monitoring (RPM) as a crucial component of primary care for patients. This page provides CPT codes and descriptions for billing remote patient monitoring (RPM) under CPT codes 99453, 99454, 99457 and 99458. Medicare and many private payer reimbursement rules compensate medical providers for prescribing and reviewing data that is produced by monitoring devices that capture/store/transmit patients’ physiological data and subsidize the device/service costs.

Every month, you receive a reimbursement of, on average, $125 per patient per month. In addition, you receive a one-time reimbursement for setup and patient education for each patient: approximately $20 per patient. These amounts will vary by location. DocuVitals provides complete, all-inclusive Platinum service that includes the vital sign device at no charge to the patient*, delivering and setting up the vital sign device with the patient, monitoring the daily vital signs of the patients, and alerting the practice whenever a patient exceeds the desired target range. You do the monthly billing to Medicare and other private payors and pay DocuVitals a low monthly fee for providing the complete service. The rest is your profit.
* May be subject to a copay

CPT 99453 – $21 (new 2019)

Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment.

CPT 99454 – $69 (new 2019)

Remote monitoring of physiologic parameter(s) (e.g., 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 99457 – $54 (new 2019)
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 99458 – $42 (new 2020)
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes