Medicare Reimbursement

Medicare Reimbursement

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 (non Facility)

    • Medicare Patients Enrolled in RPM Program

    • Service Initiation ($19.32 one time)
    • Data Transmission ($50.15/monthly)
    • Treatment MGMT (20 Min) ($48.80 monthly)
    • Treatment MGMT (additional 20 mins) $39.65/mo (Max of 3 units (60 additional minutes) per month
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      Potential Annual Gross Revenue:

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*CMS rates may vary from state to state

RPM Revenue Generator (RHC and FQHC)

    • Rural Health Clinics and Federally Qualified Health Centers Only:

    • (Flat rate of $77.94 PPM for 20 minutes of service and can only be used once per patient per month)
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      Potential Annual Gross Revenue:

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CMS CPT Billing Codes

RPM Codes

CPT 99453 - ($19.32 1 time)

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

CPT 99454 - ($50.15/mo)

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 - ($48.80/mo)

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 - (39.65/mo)

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 99091 ($54.22/mo)

Minimum of 30 minutes of time in 30-day period; no add-on code for additional time. Performed by physician/NPP or by clinical staff if "incident to" requirements are met. Requires direct (not general) supervision by billing practitioner.

Reimbursement Coding and Information is provided for educational purposes only and is in no way a guarantee of reimbursement. Providers, offices and any other organizations that plan to or currently bill for remote monitoring services, should always consult a billing professional to confirm proper billing and coding, in line with each insurance carriers policies.

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