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2025 Updates to Remote Patient Monitoring CPT Codes & Reimbursements

This article provides an updated summary of the 2025 changes to remote monitoring CPT® codes and reimbursements, highlighting expanded applicability across Medicare, Medicaid, and commercial insurance plans. For orthopedic practices exploring the benefits of remote monitoring, Prescribe FIT’s white paper, “Decode the Benefits of RPM & RTM Services for Orthopedic Practices”, offers detailed insights. For reimbursement and billing guidance, download our 2025 RPM Billing Guide.

Annual CMS Updates to Remote Monitoring

Each year, the Centers for Medicare & Medicaid Services (CMS) issues a Final Rule to update the physician fee schedule (PFS). This document standardizes reimbursement rates for medical services and incorporates changes to CPT codes, reflecting advancements in healthcare delivery. In 2025, updates to Remote Physiological Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) codes reaffirm their role in both chronic care management and episodic interventions.

Commercial payers and Medicaid programs are also adopting RPM and RTM reimbursement models, providing opportunities for broader implementation across diverse patient populations.

2025 Remote Physiological Monitoring (RPM) CPT Codes

RPM focuses on physiological metrics, such as weight, blood pressure, and oxygen saturation. It supports chronic and acute care management by leveraging devices “defined by the FDA” for data collection and transmission. The five CPT codes approved for RPM, as well as their corresponding reimbursement rates based on the 2025 National average non-facility-based payment from CMS, are as follows:

RPM CPT Codes & Reimbursement

  1. 99453: Initial setup and patient education – $19.73 (One-time)
  2. 99454: Device supply and data transmission – $43.02 (Monthly)
  3. 99457: Management services for the first 20 minutes – $47.87 (Monthly)
  4. 99458: Each additional 20 minutes (add-on) – $38.49 (Monthly)
    • Note: Medicare typically reimburses up to 3 units (60 minutes), with variability across commercial payers.
  5. 99091: Data collection and analysis (30 minutes) – $51.75 (Every 30 days)

Medicaid programs in most states and most commercial payors reimburse for RPM, often times with higher reimbursement rates. Medicaid programs often align with Medicare’s requirements, while commercial payers may have varying policies for device qualification and patient criteria. Providers should confirm coverage specifics with individual plans. During Prescribe FIT practice implementation, we will run a Payor Coverage Analysis™ on your individual state commercial payor plans. Then during patient enrollment, we also run Benefits & Coverage Eligibility (BCE)™ checks on individual patient plans.

2025 Remote Therapeutic Monitoring (RTM) CPT Codes

RTM expands beyond physiological metrics to assess treatment efficacy and therapy adherence. Common applications include musculoskeletal and respiratory conditions, allowing providers to monitor outcomes and adjust care plans in real time.

RTM CPT Codes & Reimbursement

The five CPT codes approved for RTM, as well as their corresponding reimbursement rates based on the 2025 National average non-facility-based payment from CMS, are as follows:

  1. 98975: Initial setup and patient education – $19.73 (One-time)
  2. 98976: Device supply for respiratory system – $43.02 (Monthly)
  3. 98977: Device supply for musculoskeletal system – $43.02 (Monthly)
  4. 98980: Management services for the first 20 minutes – $50.14 (Monthly)
  5. 98981: Each additional 20 minutes (add-on) – $39.14 (Monthly)

Commercial insurers and Medicaid are progressively adopting RTM reimbursement, particularly for chronic disease management and post-surgical rehabilitation. Confirm plan-specific coverage details to optimize billing practices.

Key Requirements for RPM & RTM Reimbursement

For both RPM and RTM services to qualify for reimbursement:

  • Devices must meet FDA standards.
  • Monitoring must be medically reasonable and necessary
  • Patient consent is required before initiating services
  • Data must be electronically collected and transmitted securely at least 16 days per 30-day period
  • Services can be delivered by auxiliary personnel under a supervising provider.
  • Patient engagement (e.g., interactive communication) is mandatory.

Key Differences Between RPM & RTM Requirements

  • RPM, but not RTM, requires an established patient relationship
  • RPM service must monitor an acute or chronic condition
  • RPM and RTM cannot be billed together

Conclusion

The 2025 updates highlight the growing acceptance of RPM and RTM services across Medicare, Medicaid, and commercial plans. These technologies present new opportunities for healthcare providers, including orthopedic practices, to enhance patient outcomes while generating additional ancillary revenue.

Discover the transformative potential of remote monitoring for your practice by accessing Prescribe FIT’s white paper and 2025 Billing Guide. Or contact us to get started.

Published on November 3, 2024