Whether you operate on a fee-for-service (FFS) or value-based care (VBC) practice, working remote patient monitoring into your business model can translate to better patient outcomes and additional income generation. In short, remote patient monitoring (RPM) can truly be a game changer for your and your patients—especially those with chronic or acute conditions.
But, for providers who work with Medicare or Medicaid patients, there are often questions around how much they reimburse for RPM and what CPT codes you can use. After all, this information is critical to understanding whether the financial benefits of remote patient monitoring are worthwhile for your practice.
How Does CMS Define Remote Patient Monitoring?
According to the Centers for Medicare & Medicaid Services (CMS), remote patient monitoring is defined as the “use of digital technologies to collect health data from patients in one location and electronically transmit that information securely to providers in a different location (data can include vital signs, weight, blood pressure, blood sugar, pacemaker information, etc.).” In other words, RPM allows healthcare professionals to monitor patient health data remotely with the use of devices, including blood pressure monitors, glucose monitors, pulse oximeters, scales, and more.
All of this is especially helpful when working with patients with chronic or acute conditions where monitoring vitals and health data can lead to better outcomes, such as increasing patient quality of life and decreasing hospitalizations.
Does Medicare Cover Remote Patient Monitoring?
Yes, Medicare does cover remote patient monitoring. Of course, there are restrictions in place around the reimbursements they provide medical facilities. For example, Medicare typically only covers RPM for high-risk populations, such as those who have a chronic or acute condition or are unable to access medical professionals due to geographic location.
How Much Does RPM Reimburse?
Exactly how much remote patient monitoring Medicare reimburses does vary. Geographic location may alter reimbursement amounts slightly, and some CPT codes allow for monthly repayments while others are one-time use. However, here is an average breakdown of reimbursement amounts for 2022, as well as the RPM reimbursement codes to use when filing claims.
- CPT Code 99453: A one-time $19 reimbursement is available, which includes the initial set up and delivery of RPM devices as well as patient education. At Harmonize Health, patients receive a kit with digital health tools customized for their unique needs, and our app makes it easy to get patients onboarded and tracking their information. What’s more, our fee structure is all-inclusive, so one fee includes access to all of our features.
- CPT Code 99454: A $56 per month reimbursement is available for the continuous monitoring of patient health data as well as the ongoing maintenance of RPM devices. The use of this code does require that patients submit data at least 16 days out of the month. With a 97% monthly retention, patients who use Harmonize Health stay engaged to help providers meet this metric.
- CPT Code 99457: A $50 per month reimbursement is available for providers to hold 20 minutes worth of conversations with the patient or caregiver over the course of 30 days. The use of this code requires the conversations to be specific to the data transmitted by the RPM device.
- CPT Code 99458: A $41 per month reimbursement is available for providers who spend more than 20 minutes and up to 40 minutes communicating with a patient or caregiver over the course of 30 days. Medicare does not provide additional reimbursement beyond 40 minutes. At Harmonize Health, we built in a real-time video call functionality to make these discussions quick and easy.
- CPT Code 99091: A $56 per month reimbursement is available for the interpretation of health data by qualified medical professionals. The use of this code requires that practitioners spend at least 30 minutes per month evaluating and analyzing data. Harmonize Health offers features like clinical setup and true alert identification to streamline these efforts.
In total, care providers who qualify for the full amount could be reimbursed at approximately $200 per month for an annual total of $2,400.
Is There Coverage from Medicaid on Remote Patient Monitoring?
As of spring 2022, a total of 34 state Medicaid programs cover remote patient monitoring in some form, according to the Center for Connected Health Policy (CCHP). However, restrictions on Medicaid coverage do vary quite a bit from state to state. Common restrictions state Medicaid programs place on RPM reimbursement include limiting the types of facilities that can claim reimbursements, restricting the conditions that qualify for RPM, and limiting the type of RPM devices that can be used.
What Is the Reimbursement for Remote Patient Monitoring for Medicaid?
Medicaid reimbursement for remote patient monitoring rates vary from state to state. If you do business in one of the 34 states referenced above, it’s important to review your state’s physician fee schedule and/or medical practitioner reimbursement guide.
Harmonize Health: RPM That Delivers Results
The work that goes into implementing, monitoring, and maintaining remote patient management for patients takes time—there’s no doubt about it. That’s why it’s important to work with an RPM provider that understands that return on investment matters. At Harmonize Health, our program delivers:
- 43% reduction in ER visits
- 61% reduction in hospital admissions
- 70% increase in patient engagement
- 40% increase in patient satisfaction
All of this translates into patients that actually use their devices so you can access their health data, monitor their results, deliver excellent patient care, and ultimately bring in more income with your Medicare and Medicaid reimbursements. Ready to take the next step? Schedule a demo to see how Harmonize Health can help your patients and your practice.
