Medicare Reimbusement

Medicare Reimbusement

RPM for Monthly Recurring Revenue

Covered RPM procedures include: setup and training for monitoring devices. Providers can also expect monthly recurring reimbursements for equipment transmissions and monitoring.

How Does This Process Work?

  • The Provider issues a remote physiological monitoring (RPM) device or device kit to the patient. (Scale, Blood Pressure, Pulse Ox, Glucometer, Thermometer, EKG, Medication)
  • The Patients use the devices from home each day. As the device generates patient data, the information is transmitted digitally to the cloud portal. This greatly simplifies the data review and follow-up process.

CMS issues reimbursements for:

  • A one-time payment (per patient) for initial equipment setup and training CPT 99453
  • Monthly recurring payments for device transmission, CPT 99454
  • Monthly recurring payments for patient monitoring, CPT 99457, 99458

If you have further questions about reimbursement, please visit our contact page. We would love to help you with any questions you may have!

RPM Revenue Generator

    • Medicare Patients Enrolled in RPM Program

    • Device education and training ($21 one time)
    • Device/transmission reimbursement ($69/monthly)
    • Data Interpretation, 20 minutes/month of clinical staff with patient ($54 monthly)
    • Additional Care time to 99457 for each 20 minutes of incremental care $42 (can bill 99458 multiple times)
    • Additional One-Time codes

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      Potential Annual Gross Revenue:

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CMS CPT Billing Codes

RPM Codes

CPT 99457 - $54

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

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.

CPT 99453 - $21

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

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.

CCM & TCM Codes

HCPCS G2058 - $38

Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (limit 2x per month).

HCPCS G0506 - $64

Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to code for primary procedure).

CPT 99495 - $188

Transitional Care Management Services with the following required elements: Medical decision making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge.

CPT 99496 - $248

Transitional Care Management Services with the following required elements: Communication (Direct contact, Telephone, Digital) with the patient and/or caregiver within 2 business days of discharge; Medical decision making of high complexity during the service period; face-to-face visit thin 7 calendar days of discharge.

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