How to Bill RPM

What represents an “interactive communication” and how does it alter CPT 99457 & 99458?

Since January 1, 2021, the 20 minutes required to bill CPT 99457 and 99458 must include some time for interactive communication, but not all.

What is Interactive communication?

“a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.”

Clarification from CMS on interactive communication requirements. 

“We agree with commenters that our description of the required 20 minutes of time associated with CPT codes 99457 and 99458 should include care management services, as well as synchronous, real-time interactions. That is, we agree that “interactive communication” as we defined it in the CY 2021 PFS proposed rule contributes to the total time, but is not the only activity that should be included in the total time.”

Additional RPM Clarifications 

• CPT 99454 can be billed only once per 30-day period, no matter how many devices are provided, with a minimum of 16 days of data. 
• CPT 99453 (setup) and CPT 99454 (device) both require the use of a medical device transmitting digitally.
• Patients with acute and chronic conditions are both eligible for RPM. 
• RPM services can be ordered and billed only by physicians or NPPs who are eligible to bill Medicare for E/M services.
• CPT codes 99457 and 99458 can be furnished by clinical staff under general supervision.
• Auxiliary personnel (which includes other individuals who are not clinical staff but are employees or leased or contracted employees) can furnish CPT codes 99453 and 99454 under the general supervision of the billing physician or practitioner.

CPT Codes for RPM

99453 - Initial Setup & Patient Education

• Remote monitoring of physiologic parameter(s), (for example, weight, blood pressure, pulse oximetry, respiratory flow rate) initial; setup and patient education on equipment use. 
  • Minimum 16 days of readings
  • Billed once per episode of care
  • Auxiliary, clinical or QHP

99454 - Equipment & Monitoring

• Patients provided with FDA defined medical device(s) with daily recording(s) or programmed alert(s) transmission, each 30 days. 
  • Minimum 16 days of readings
  • Minimum must be met to bill additional codes
  • Auxiliary, clinical or QHP

99457 - Interventions & Monitoring

• Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional.
  • Care management
  • Can be billed if under 20 minutes of time
  • Interactive communication with patient required
  • Clinical or QHP

99458 - Additional Interventions & Monitoring

• Remote physiologic monitoring treatment management services, 40 minutes or more of clinical staff/physician/other qualified healthcare professional.
  • Care management
  • Can be billed twice*
  • Bill once for under 40 minutes of time
  • Additional bill for under 60 minutes of time