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2023 Updates to Remote Monitoring CPT Codes & Reimbursements

VIEW THE LATEST ARTICLE: 2024 Updates to Remote Monitoring CPT Codes & Reimbursements

The following article offers a brief summary of the 2023 updates to remote monitoring CPT codes & reimbursements. For more information on remote monitoring for orthopedics, request access to Prescribe FIT’s white paper at https://www.prescribefit.com/rpm-ortho-guide/


Each year, the Centers for Medicare & Medicaid Services (CMS) releases a Final Rule containing updates to the physician fee schedule (PFS): a comprehensive list of standardized fees used by CMS to reimburse doctors and other providers for their services to patients.

Each reimbursable service is assigned a corresponding Current Procedural Terminology (CPT) code to streamline reporting and billing.

2023 RPM CPT codes explained

Remote patient monitoring or remote physiologic monitoring (RPM) involves the use of non-face-to-face technology to monitor and analyze physiological metrics of patients’ health such as oxygen saturation, blood oxygen levels, weight loss/gain, etc.

According to CMS rules, RPM services must meet the following criteria to qualify for reimbursement:

  1. The RPM service must monitor an acute care or chronic condition.
  2. The device used to collect and transmit data must meet the FDA definition of a medical device.
  3. RPM data must be collected for at least 16 out of 30 days each month.
  4. Data must be electronically collected and automatically uploaded to a secure location made available to the billing practitioner.
  5. The RPM service may be provided by auxiliary personnel under general supervision of the billing practitioner.

The five CPT codes approved for RPM, as well as their corresponding reimbursement rates, are as follows:

2023 RPM CPT Codes & Reimbursement Rates

99453: Initial set-up & monitoring

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.

Reimbursement: $19.32 (One-time)

99454: Continued monitoring over 16-days

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.

Reimbursement: $50.15 (Every 30 days)

99457: Management services for initial 20 minutes

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.

Reimbursement: $48.80 (Every 30 days)

99458: Management services for each additional 20 minutes up to 60 minutes

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; each additional 20 minutes.

Reimbursement: $39.65 (Billed up to 3x every 30 days)

99091: Collecting and analyzing physiologic data

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.

Reimbursement: $54.22 (Every 30 days)

*Note that the actual reimbursement rates may vary.

Other Changes to RPM in 2023

CMS established three non-reimbursable CPT codes that home health organizations will be required to report on effective July 2023. The data gathered from these codes will help inform the potential expansion of RPM reimbursements to home health services.

2023 RTM CPT codes explained

Remote therapeutic monitoring (RTM) involves the use of medical devices to monitor non-physiological data on patient health and treatment response. In other words, rather than just collecting data, RTM measures the effectiveness of a treatment and/or the patients’ condition.

According to the 2023 CMS Final Rule, RTM technology can be used to measure respiratory system status, musculoskeletal system status, therapy adherence, and therapy response. This can include patients’ self-reported pain levels.

There are currently 5 RTM billing codes approved for Medicare payment in 2023. The codes and their 2023 reimbursement rates are:

98975: Initial setup & education

Remote Therapeutic Monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on the use of equipment.

Reimbursement: $19.32 (One-time)

98976: Device supply for respiratory system

Remote therapeutic monitoring device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system.

Reimbursement: $50.15 (Every 30 days)

98977: Device supply for musculoskeletal system

Remote therapeutic monitoring device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system.

Reimbursement: $50.15 (Every 30 days)

98980: Management services for initial 20 minutes

Remote Therapeutic Monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes

Reimbursement: $49.48 (One-time)

98981: Management services for each additional 20 minutes

Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month.

Reimbursement: $39.65 (Every 30 days)

*Note that the actual reimbursement rates may vary.

Other changes to RTM in 2023

CMS proposed a new rule in 2023 to replace RTM CPT codes 98980 and 98981 with a set of four new G-codes. These new codes were meant to expand the provision of RTM by allowing non-physician practitioners and non-physician qualified healthcare professionals to bill for the codes.

CMS did not finalize these changes for 2023, so eligible providers may continue to bill the original 5 CPT codes for RTM. In the 2023 final rule, however, CMS declared that “Any RTM service may be furnished under our general supervision requirements.”

Additionally, CMS approved a new code for the supply of a device for cognitive behavioral therapy monitoring for 2023: CPT 989X6. Unlike the other CPT codes in this category, there is not yet a standard reimbursement amount for this code.

Conclusion

CMS reaffirmed its commitment to expanding coverage of both RPM and RTM services for 2023 with the introduction of new CPT codes and other changes to improve provision and access. In addition, CMS will extend the flexibilities of RPM and RTM authorized during the COVID-19 pandemic through the end of 2023.

With the opportunity for reimbursement, RPM and RTM can be valuable ancillary revenue services for healthcare professionals. In Prescribe FIT’s latest white paper, we “Decode the Benefits of RPM & RTM Services for Orthopedic Practices.” Visit https://www.prescribefit.com/rpm-ortho-guide/ to request access to the full report.

 

About Prescribe FIT

Prescribe FIT is a full-service remote monitoring and virtual lifestyle health solution for orthopedics. We extend orthopedic care beyond the office by helping patients make simple changes to physical activity, nutrition, and lifestyle to address the root causes of their musculoskeletal issues and improve their health and wellbeing everyday: not just during scheduled appointments. Visit https://www.prescribefit.com/get-started/ to learn more.

Published on February 15, 2023