Over the past several years, the Centers for Medicare and Medicaid Services (CMS) have worked to expand reimbursement codes available for remote patient monitoring as a way to continue to help providers respond to the growing shift and demand for virtual care services.
Remote Patient Monitoring services are billable to Medicare. CPT 99457 and CPT 99458 codes for remote patient monitoring services fall under the Medicare "general supervision" billing rule, which means physicians can sub-contract the services out to us. Our TriCare Team will become an extension of their practice.
Physicians can also bill CPT codes 99453 and 99454 for reimbursement of expenses associated with providing remote monitoring services used to collect remote physiologic parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate). This includes the cost associated with the monitoring device and distribution of the device to the patient. In order to bill for 99453 and 99454, data from an RPM medical device must be transmitted for a minimum of 16 days in a 30-day period.
99453 is a one-time reimbursement code related to setup taking into consideration the effort spent educating a patient about the device they're going to be using for monitoring their particular condition (can be billed only once per episode of care per patient regardless of the number of monitoring devices being used).
99454 is related to the supply of the device (or devices) to be used for monitoring. The device must be ordered by the patient's physician or other qualified healthcare provider. 99454 can be reported every 30 days. However, 99454 can be billed by only one practitioner, only once per 30-day period, per patient, regardless of the number of devices used.
We help provide medical practices with value-based reimbursement.
Example:
With TriCare's remote care coordination services of 250 patients (CPT code 99457), a physician or specialist office could generate $3800/month ($46,000/year). Physicians and specialists can also receive $14,000/month as reimbursement (CPT code 99454) for supplying the remote monitoring device(s) to these same 250 patients. Additional income could be generated if the patient(s) required 20 or 40 more minutes of care coordination services during the same billing period (calendar month). Note: In order to bill for 99453 and 99454, data from an RPM medical device must be transmitted for a minimum of 16 days in a 30-day period.
Examples are only used for illustrative purposes that are based on assumptions of patient participation and population, deductions of TriCare's fees, current Medicare fee schedules, deductions of care coordination fees a specific MAC locality: 0441218 Houston. Examples excludes any possible start-up costs and purchase or lease of remote monitoring equipment.