{"id":23796,"date":"2021-09-06T18:32:38","date_gmt":"2021-09-06T13:02:38","guid":{"rendered":"https:\/\/mobisoftinfotech.com\/resources\/?p=23796"},"modified":"2025-11-26T14:27:09","modified_gmt":"2025-11-26T08:57:09","slug":"remote-patient-monitoring-system-in-2021","status":"publish","type":"post","link":"https:\/\/mobisoftinfotech.com\/resources\/blog\/remote-patient-monitoring-system-in-2021","title":{"rendered":"Updated CPT Codes Elevating Remote Patient Monitoring Systems in 2021"},"content":{"rendered":"<p>CPT codes, which are used to bill clients for healthcare services in the medical industry. In terms of RMP (remote patient monitoring), this means billing clients for monitoring their health remotely and providing healthcare services. The CPT codes are used for billing the Centers for Medicare and Medicaid Services (CMS), thereby creating a revenue model for small and medium medical care providers.<\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">In 2021, updates were made to the CPT codes with regards to RPM, making it more robust and increasing reimbursement charges for RPM providers. This change has made it so that these providers will now be able to bill patients more for using a remote monitoring system to gather patient data from their homes.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><b>Why did CMS Expand the CPT codes?<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">In summary, the updated CPT codes made changes to the <\/span><a href=\"https:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Payment\/PhysicianFeeSched\" rel=\"nofollow\"><span style=\"font-weight: 400;\">Medicare Physician Fee Schedule<\/span><\/a><span style=\"font-weight: 400;\"> (PFS). It aims to make the reporting process more streamlined to evaluate patient management services, and it increases the value of all these services.&nbsp;<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">These changes were brought about with new requirements for remote patient monitoring and related services due to the onset of the Covid-19 outbreak. The CMS made clear what services are billable and what remote monitoring services are allowed. Before Covid-19, these devices need at least 16 days\u2019 worth of data within 30 days to qualify for billing. But during Covid, CMS required less than 16 days.<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><b>Prerequisites for RPM Billing<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">To bill a client for RPM services, certain requirements need to be met to qualify for it:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"> <\/span><span style=\"font-weight: 400;\">All medical practitioners should be practicing following the applicable state law. All RPM services are allowed to be performed by any qualified healthcare professional as long as they comply with the laws.<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Previously the CMS required patients to be considered as having \u201c<\/span><a href=\"https:\/\/www.cdc.gov\/chronicdisease\/about\/index.htm\" rel=\"nofollow\"><span style=\"font-weight: 400;\">chronic conditions<\/span><\/a><span style=\"font-weight: 400;\">\u201d to qualify for RPM billing. Now even acute patients can be monitored using RPM.<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Before, the technology used for these services should be a medical device that is approved and cleared by the FDA (Food and Drug Administration). Now, these devices, such as blood pressure monitors, do not need to be cleared, only defined by the FDA to qualify.<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Two-way in-person communication is not required to qualify for remote patient monitoring reimbursement.<\/span><\/li>\n<\/ul>\n\n\n\n<h2><b>Updated RPM CPT Codes for 2021<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">&nbsp;Here is the updated list of the CPT code for home health care:<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>1<\/span> <b>CPT Code 99453<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This code covers the one-time cost that healthcare providers can charge for enrolling the patient into the new system. This includes the time they spent setting up the CMS remote patient monitoring systems, teaching the patient how to use the system, and any other services that come along with this. Healthcare providers are now able to bill for this code once during 30 days.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>2<\/span> <b>CPT Code 99454<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This CPT code allows providers to bill monthly. It is a reimbursement for the cost of leasing the home health care device to the patient, which includes the software used to run this service. The device should not be previously owned by the patient but instead should be provided by the healthcare professional. The device must only be used for home care and needs to automatically upload the data to the provider daily.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>3<\/span> <b>CPT Code 99457<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This is the reimbursement for time spent monitoring a patient\u2019s health data. Example &#8211; blood pressure, pulse, and weight. This can be billed every month but requires at least 20 minutes of monitoring for each month.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>4<\/span> <b>CPT Code 99458<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This is an add-on to the previous code 99457, stating that healthcare providers can be reimbursed for every additional 20 minutes every month of active monitoring of the patient\u2019s health data.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>5<\/span> <b>CPT Code 99091<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This CPT code for medication monitoring looks at the time spent analyzing and interpreting the health data they receive from patients. At least 30 minutes need to be spent every 30 days to qualify for the reimbursement.<\/span><\/p>\n\n\n\n<h2><b>10 Most Significant Takeaways from the \u2018Final Rule\u2019<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.cms.gov\/files\/document\/12120-pfs-final-rule.pdf\" rel=\"nofollow\"><span style=\"font-weight: 400;\">Final Rule<\/span><\/a><span style=\"font-weight: 400;\"> is what addresses all the changes to the PFS, RPM, and other healthcare services done remotely. Here is what we can learn from the changes:<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>1<\/span> <b>Clarifying RPM device requirements<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Previously, the CMS stated that for a device to be used to collect data, it needs to be approved and cleared by the FDA and that the data needs to be collected automatically rather than from the patient. As of late, there have been a few systems that require patients to manually upload this data, either by taking pictures or entering them into the system. This change clarifies that unless the device sends the information automatically, it cannot be used.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>2<\/span> <b>Interactive communication<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">It was clarified that interactive communication associated with the CPT codes 99457 and 99458 also included care management delivery and services and real-time association. Previously, healthcare providers were worried that text messaging, care planning, and other similar interactions would not be counted inside this 20 minutes.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>3<\/span> <b>Acquiring consent from patients<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Previously, consent was required in advance from the patient to continue with the RPM service. The final rule allows for consent to be received during the initial setup of the services instead.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>4<\/span> <b>Provided coverage for acute patients<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Now, RPM services can be administered to patients suffering from acute conditions as well. Previously, only patients with chronic conditions were considered to receive RPM care.&nbsp;<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>5<\/span> <b>Relationship between patient and physician<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Due to Covid-19, the rule where physicians need to have an ongoing relationship with the patient to provide RPM services was removed to accommodate the growing need. However, the final rule reestablishes this rule, deeming that a patient-physician relationship is necessary.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>6<\/span> <b>Policy for delivery of services by auxiliary personnel<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Auxiliary personnel is the individuals who are directly working under the guidance\/supervision of a qualified physician. They are considered auxiliary personnel as an employee of the healthcare provider or even if they are independent contractors or any other type of worker. The CMS approved a policy that allows these auxiliary workers to administer services even if they are not under direct supervision. They can do this for both CPT codes 99453 and 99454.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>7<\/span> <b>Who can bill for RPM services<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">This is a clarification that was already understood by most practitioners. It states that only physicians who can furnish evaluation and management services are qualified for billing RPM services for all the updated CPT codes. They also clarified that only one practitioner is allowed to bill for codes 99453 and 99454 during those 30 days. They are also required to check with the patient if they are already working with any other practitioners before providing the service.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>8<\/span> <b>Reconfirming the 16 days<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Due to pushes from the industry trying to get this period dropped down to a lower figure, the CMS reconfirmed that there needs to be a minimum of 16 days\u2019 worth of data to bill for CMS using these CPT codes.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>9<\/span> <b>Billing for code 99091<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Before 2019, the code for billing was 99091. When the new code 99457 was released, professionals were unsure whether the old code 99091 can be used for billing as well while the 99457 code was still in play.&nbsp;<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">However, the final rule confirmed that practitioners are now able to bill for complex RPM management when they spend a lot of time managing patient data and going through a care plan with them. They also clarified that the 99091 can also be billed within the same 30-day period without affecting the 99457 medicare CPT code reimbursement.<\/span><\/p>\n\n\n\n<h5 class=\"subtitle-list\"><span>10<\/span> <b>The Two-Measurement Day Waiver<\/b><\/h5>\n\n\n\n<p><span style=\"font-weight: 400;\">Due to Covid, a temporary measure was taken allowing for billing with only two measurement days if a patient is suspected of Covid or has contracted Covid. The final rule confirmed that this applies only to patients who are suspected or have confirmed that they have Covid-19.<\/span><\/p>\n\n\n\n<a href=\"https:\/\/mobisoftinfotech.com\/resources\/blog\/how-human-centered-design-transforms-patient-experience\"><figure class=\"wp-block-image size-full\"><noscript><img decoding=\"async\" width=\"855\" height=\"120\" src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2021\/09\/inline-cta.png\" alt=\"Learn the essence of healthcare design experience enriching Rx and EHR management \" class=\"wp-image-23812\"><\/noscript><img decoding=\"async\" width=\"855\" height=\"120\" src=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%22http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%22%20viewBox%3D%220%200%20855%20120%22%3E%3C%2Fsvg%3E\" alt=\"Learn the essence of healthcare design experience enriching Rx and EHR management \" class=\"wp-image-23812 lazyload\" data-src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2021\/09\/inline-cta.png\"><\/figure><\/a>\n\n\n\n<h2><b>The Prominence of Remote Patient Monitoring<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">As stated, the RPM billing service cannot be performed by any provider of the service. There are certain criteria they fall under to be eligible. Here are the providers who can perform RPM billing:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"> <\/span><span style=\"font-weight: 400;\">Qualified healthcare professionals<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"> <\/span><span style=\"font-weight: 400;\">Qualified clinical staff such as medical assistants<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Physicians<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Companies that can set up and maintain RPM devices<\/span><\/li>\n<\/ul>\n\n\n\n<p><span style=\"font-weight: 400;\">The RPM technology has been around for some time but was given its time to shine when the pandemic broke out. With hospitals going over their capacity to supply, and a need for remote telehealth services, the RPM service came as welcome relief for both patients and providers.&nbsp;<\/span><\/p>\n\n\n\n<h5>Patients can receive:<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"> <\/span><span style=\"font-weight: 400;\">Detailed information on their physical health without visiting a hospital<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Immediate access to healthcare<\/span><\/li>\n<\/ul>\n\n\n\n<h5>Providers and professionals can benefit from:&nbsp;<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">An increasing number of patients with favorable outcomes<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">Easier compliance with patients<\/span><\/li>\n\n\n\n<li><span style=\"font-weight: 400;\"> <\/span><span style=\"font-weight: 400;\">A growing list of insurances and reimbursements<\/span><\/li>\n<\/ul>\n\n\n\n<p><span style=\"font-weight: 400;\">With these new CPT codes brought in, these providers and practices can be fully reimbursed for the services they provide, which was a problem in the past. Here are some ways they can generate revenue:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">CPT code 99453 &#8211; They can earn a little under $25 per patient as a one-time fee<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">CPT code 99454 &#8211; They can earn $990 for every patient per year<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">CPT code 99457 &#8211; They can earn about $730 per patient each year<\/span><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">CPT code 99458 &#8211; They are potentially able to earn about $1150 per year for each patient<\/span><\/li>\n<\/ul>\n\n\n\n<h2><b>Bottomline,<\/b><\/h2>\n\n\n\n<p><span style=\"font-weight: 400;\">A Remote Patient Monitoring system is proving to be invaluable during the Covid-19 pandemic. But, even after this time has passed, RPM services provide a lot of value for patients who are not able\/not willing to leave home.&nbsp;<\/span><\/p>\n\n\n\n<p><span style=\"font-weight: 400;\">With the new CPT codes, creating a revenue stream through providing RPM services has become easier and more profitable than ever. For help with setting up RPM solutions for your healthcare practice, <\/span><a href=\"https:\/\/mobisoftinfotech.com\/\"><span style=\"font-weight: 400;\">Mobisoft<\/span><\/a><span style=\"font-weight: 400;\"> can deliver custom comprehensive software that fits your specific needs.<\/span><\/p>\n\n\n\n<a href=\"https:\/\/mobisoftinfotech.com\/contact-us?utm_source=blog_cta&#038;utm_campaign=remote-patient-monitoring-system-in-2021-cta1\"><figure class=\"wp-block-image size-full\"><noscript><img decoding=\"async\" width=\"855\" height=\"363\" src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2021\/09\/CTA-1.png\" alt=\"It is a great time to make use of RPM services to bring in additional revenue to your business\nTalk to us today and get started \n\" class=\"wp-image-23803\"><\/noscript><img decoding=\"async\" width=\"855\" height=\"363\" src=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%22http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%22%20viewBox%3D%220%200%20855%20363%22%3E%3C%2Fsvg%3E\" alt=\"It is a great time to make use of RPM services to bring in additional revenue to your business\nTalk to us today and get started \n\" class=\"wp-image-23803 lazyload\" data-src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2021\/09\/CTA-1.png\"><\/figure><\/a>\n\n\n<div class=\"modern-author-card\">\n    <div class=\"author-card-content\">\n        <div class=\"author-info-section\">\n            <div class=\"author-avatar\">\n                <noscript><img decoding=\"async\" src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2020\/11\/Shailendra.png\" alt=\"Shailendra Sinhasane\"><\/noscript><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt=\"Shailendra Sinhasane\" data-src=\"https:\/\/mobisoftinfotech.com\/resources\/wp-content\/uploads\/2020\/11\/Shailendra.png\" class=\" lazyload\">\n            <\/div>\n            <div class=\"author-details\">\n                <h3 class=\"author-name\">Shailendra Sinhasane<\/h3>\n                <p class=\"author-title\">Co-founder and CEO<\/p>\n                <a href=\"javascript:void(0);\" class=\"read-more-link read-more-btn\" onclick=\"toggleAuthorBio(this); return false;\">Read more <noscript><img decoding=\"async\" src=\"\/assets\/images\/blog\/Vector.png\" alt=\"expand\" class=\"read-more-arrow down-arrow\"><\/noscript><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt=\"expand\" class=\"read-more-arrow down-arrow lazyload\" data-src=\"\/assets\/images\/blog\/Vector.png\"><\/a>\n                <div class=\"author-bio-expanded\">\n                    <p>Shailendra Sinhasane (Shail) is the co-founder and CEO of <a href=\"https:\/\/mobisoftinfotech.com\" target=\"_blank\" rel=\"noopener\">Mobisoft Infotech<\/a>. He has been focused on cloud solutions, mobile strategy, cross-platform development, IoT innovations and advising healthcare startups in building scalable products.<\/p>\n                    <div class=\"author-social-links\"><div class=\"social-icon\"><a href=\"https:\/\/www.linkedin.com\/in\/sunshail\/\" target=\"_blank\" rel=\"nofollow noopener\"><i class=\"icon-sprite linkedin\"><\/i><\/a>\n                     <a href=\"https:\/\/twitter.com\/sunshail\" target=\"_blank\" rel=\"nofollow noopener\"><i class=\"icon-sprite twitter\"><\/i><\/a><\/div><\/div>\n                    <a href=\"javascript:void(0);\" class=\"read-more-link read-less-btn\" onclick=\"toggleAuthorBio(this); return false;\" style=\"display: none;\">Read less <noscript><img decoding=\"async\" src=\"\/assets\/images\/blog\/Vector.png\" alt=\"collapse\" class=\"read-more-arrow up-arrow\"><\/noscript><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" alt=\"collapse\" class=\"read-more-arrow up-arrow lazyload\" data-src=\"\/assets\/images\/blog\/Vector.png\"><\/a>\n                <\/div>\n            <\/div>\n        <\/div>\n        <div class=\"share-section\">\n            <span class=\"share-label\">Share Article<\/span>\n            <div class=\"social-share-buttons\">\n                <a href=\"https:\/\/www.facebook.com\/sharer\/sharer.php?u=https%3A%2F%2Fmobisoftinfotech.com%2Fresources%2Fblog%2Fremote-patient-monitoring-system-in-2021\" target=\"_blank\" class=\"share-btn facebook-share\"><i class=\"fa fa-facebook-f\"><\/i><\/a>\n                <a href=\"https:\/\/www.linkedin.com\/sharing\/share-offsite\/?url=https%3A%2F%2Fmobisoftinfotech.com%2Fresources%2Fblog%2Fremote-patient-monitoring-system-in-2021\" target=\"_blank\" class=\"share-btn linkedin-share\"><i class=\"fa fa-linkedin\"><\/i><\/a>\n            <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT codes, which are used to bill clients for healthcare services in the medical industry. In terms of RMP (remote patient monitoring), this means billing clients for monitoring their health remotely and providing healthcare services. The CPT codes are used for billing the Centers for Medicare and Medicaid Services (CMS), thereby creating a revenue model [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":23797,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"","footnotes":""},"categories":[286],"tags":[2134,2132,2137,2135,2136,2133,2138,2131,2130],"class_list":["post-23796","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-billing-for-remote-patient-monitoring","tag-cms-remote-patient-monitoring","tag-cpt-code-for-home-health-care","tag-cpt-code-for-medication-monitoring","tag-hospital-payment-monitoring-program","tag-medicare-cpt-code-reimbursement","tag-medicare-reimbursement-codes","tag-remote-patient-monitoring-reimbursement","tag-remote-patient-monitoring-system"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - 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