Using acronyms is supposed to make communication easier and faster. But what happens when there’s a long acronym that gets shortened to a shorter acronym, but that shorter acronym already means something else? Confusion, that’s what happens. And that’s exactly what’s happening with remote patient monitoring (RPM) and remote physiological monitoring (also RPM), two similar but distinct billable Medicare services.
What is remote patient monitoring?
Generally speaking, remote patient monitoring (RPM) is a subset of telehealth that involves the collection, transmission, evaluation and communication of patients’ health data from electronic devices. These devices can include handheld medical equipment, as well as implanted equipment and wearable sensors.
The Center for Connected Health Policy defines RPM as the use of “digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for assessment and recommendations.”
While RPM has been around for some time, payers and providers have yet to settle on a standard definition. This, in and of itself, can cause confusion. The Centers for Medicare and Medicaid Services, for example, does not even consider RPM to be “telehealth.” Since 2018, it has had its own CPT code, separate from telehealth.
CPT 99091: Collection and interpretation of physiologic data by a physician or qualified health care professional (QHCP) when at least 30 minutes of professional time is dedicated to the patient per 30-day period.
To bill for this variety of RPM, no chronic condition is required, nor is care planning. One requirement is that the service be performed by a physician or QHCP; it cannot be done by clinical staff.
The move to give RPM its own CPT code was seen (and confirmed by CMS) as a first step in encouraging providers to leverage the efficiency and effectiveness of RPM. But eligibility was still fairly limited prior to the pandemic. However, in response to the COVID-19 public health emergency, policy changes expanded RPM coverage to include new patients and patients with acute conditions, as well as those with chronic conditions. While these policy changes are temporary for now, many healthcare professionals are keen on making them permanent and are taking steps to ramp up RPM capacity in their practices.
What is remote physiological monitoring (RPM)?
For Medicare beneficiaries with chronic conditions (i.e. the majority of Medicare beneficiaries), CMS created a distinct type of remote monitoring, dubbed “remote physiological monitoring,” which, just like RPM, can include blood pressure, weight, pulse, pulse oximetry, respirations, respiratory flow rates and blood sugar. These data must be collected and transmitted to the provider via one or more medical devices, as defined by the FDA. What’s more, remote physiological monitoring is a care coordinated service done in real time throughout the month by a care coordinator in the practice.
Remote physiological monitoring has a family of CPT codes associated with it.
CPT Code 99453: Initial setup and patient education on use of equipment.
CPT Code 99454: Device(s) supply with daily recordings or programmed alerts transmission each 30 days.
Note: The above services must be ordered by a physician or QHCP, but the service can be carried out by clinical or non-clinical staff.
CPT Codes 99457/99458: Remote physiologic monitoring treatment management services (RPMTMS), which includes 20 minutes or more of clinical staff/physician/qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
If you’re thinking these codes sound a lot like chronic care management (CCM) service, you’re exactly right. But they are different. And in fact, practices that have CCM programs can bill for both CCM and RPM. “But there’s no double-dipping,” says Faith Jones, HealthTechS3 director of care coordination and lean consulting. “Time must be tracked separately for each service.”
These are just some of the basic differences between these similar but distinct services. Ready to learn more about RPM, care coordination-specific RPM, and how to incorporate them into your healthcare practice? Tune in on April 14 for the webinar, Remote Patient Monitoring vs. Remote Physiological Monitoring—Know Your Acronyms. Don’t delay; get your spot today.