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Billing and Revenue RPM

Definitive Guide to CPT® Code 99453

Optimize Health | 09 January 2024
5 minute read

This content is designed to provide information to the reader. Any information in this blog or the additional links should not be construed as legal advice to any individual or entity, and is not provided in the context of an attorney-client relationship. Further nothing in this blog should be construed as a guarantee of reimbursement.

Remote patient monitoring (RPM) specific CPT® codes reimburse providers for providing RPM services. There are 4 primary codes that most practices use for RPM: 

  • CPT® code 99453 for initial patient set-up and education
  • CPT® code 99454 for 16 days of patient data transmission (in a 30-day period)
  • CPT® Codes 99457 and 99458 for clinical monitoring time per calendar month

This blog focuses on CPT® code 99453.

The Top Things You Need to Know to Bill CPT® Code 99453 

CPT® code 99453 covers the initial patient setup and education, where the patient is educated on how to use the device that they will use in your Remote Physiologic Monitoring (RPM) program. For example, this would mean showing the patient how to use a blood pressure monitor to check their blood pressure, a scale to measure their weight, or a pulse oximeter to check their blood oxygen saturation levels, etc.

Here are the most important things you need to know before billing CPT® Code 99453.

  1. Who Can Order 99453? An ordering provider (a physician or other qualified healthcare provider) can order RPM for the patient. Note: while the patient does not need to have an official diagnosis, the ordering provider should only prescribe an RPM program to a patient if the provider believes the remote physiologic monitoring is medically necessary. Common conditions that are monitored via RPM include: hypertension, diabetes, chronic kidney disease, and congestive heart failure.
  2. Patients Must Provide Consent to Participate. Once you have the RPM order, the patient must provide consent to participate in the program. Patient consent can be given in writing or verbally and should be documented in the patient’s medical record.
  3. One-Time Use Code. 99453 is a one-time code and can only be billed once per patient per episode of care. If you provide the patient with two devices at setup or add a second device for the same episode of care, you cannot bill for 99453 twice. An episode of care begins when the patient is enrolled in RPM and ends when the patient’s treatment goals are met. If the patient meets their goals, is discharged from RPM, and later re-enrolled into RPM, you can then bill 99453 for this patient’s new episode of care. 
  4. Patient Setup and Education. To bill for 99453, the patient must be set up and provided with education on how to use a device to take their readings, such as a blood pressure monitor, pulse oximeter, weight scale, glucometer, and others. These devices must meet the FDA definition of a medical device, and we recommend choosing an RPM partner that provides FDA-regulated devices for at-home use. To help the patient with setup and education, it’s best to have someone from your RPM vendor or one of your care team members meet with the patient to help get the device activated, show the patient how it works, and when–and how often–they should take a reading.  We recommend that the patient successfully takes their first reading during this session.
  5. Dependency on 99454 and the 16-Day Requirement. Even once you have the patient setup and educated on how to use their device, you cannot bill for 99453 until the patient has taken 16 days of readings within 30 days, which is the requirement for CPT® code 99454. These readings must be 16 separate days, not 16 readings in total. So, if a patient is provided a device but has not yet met the required 16 days of readings within 30 days for CPT® Code 99454, you cannot yet bill for 99453.
  6. Reimbursement Rates. The national average reimbursement rate for 99453 is approximately $19.65, but rates will vary by geography and location. Optimize Health does not interpret or define the CMS RPM codes and recommends that you refer to your billing specialist or MAC office for guidance. 

Optimize Health’s Best Practices for Meeting CPT® Code 99453 Requirements

Patient setup is the ideal time to establish your expectations for each patient’s engagement and participation in your RPM program. If you simply hand a patient a device or ship it to their home without an onboarding appointment to educate the patient and set expectations, the patient may not comply with the RPM program requirements. 

To maximize patient engagement, we recommend:

  1. Cellular Devices are Patient Friendly Devices: To drive higher patient adherence, it’s critical to provide easy-to-use devices for your patients so there’s minimal technology barriers. Cellular devices are extremely easy to use and require no setup.  For example, a patient using a cellular blood pressure device only has to push one button to take a reading and transmit the data. In contrast, Bluetooth devices require a smart device, mobile app, and internet connection. Pairing, syncing, and updating apps can be challenging for non-tech savvy patients. 
  2. Conduct a Personalized Onboarding Appointment: Whether it’s conducted in-person or remotely, a personalized and interactive conversation is critical for engaging patients with RPM. During the RPM appointment, an RPM expert should show the patient how to use the device, coach them through their first reading, explain their RPM treatment plan (frequency and timing of readings), and set expectations for ongoing communication with the monitoring team.
  3. Provide Flexible Onboarding Options: An onboarding event at your office, where your staff has dedicated in-person RPM appointments with new RPM patients, is a great way to engage patients in RPM from Day 1. However, not every patient may be willing or able to attend an in-office visit for RPM. Remote onboarding with direct device shipping can be a great way to boost RPM participation for patients as your RPM program grows.
  4. Start Daily Monitoring Immediately: While the first reading should be taken during the onboarding appointment, you still need the patient to take 15 more days of readings after the onboarding to meet the 99454 16-day requirement, and bill for 99453. Your clinical monitoring team —whether that is your own staff or your RPM partner’s staff —should start engaging with your patients the day after onboarding to encourage daily readings.

Want to Learn More about How to Bill for RPM?

Set up a free consultation with one of RPM experts to get more information on RPM CPT® codes.