Remote patient monitoring (RPM) is a type of telehealth that allows providers to monitor patients’ health outside of a traditional clinical setting using digital medical devices. RPM uses technology to electronically transmit information between patients and clinicians.  

This is accomplished through a combination of Internet of Things (IoT) and cloud computing to track machine performance. Some examples include blood pressure cuffs, glucometers, pulse oximeters, and scales.

Current Procedural Terminology (CPT) codes for RPM services

These services are currently split into two categories in the Current Procedural Terminology (CPT®) to help understand their uses.   

Currently, there are two RPM device monitoring codes, 99453 and 99454, and two-timed RPM management services codes, 99457 and 99458.  

CPT 99453 covers the time it takes to enroll patients in RPM and get them set up on their devices. It can only be billed once per patient enrollment. CPT 99454 is the monthly RPM code associated with monitoring and evaluating patient data transmitted from the connected device. Today, clinicians can only bill this code in each 30-day period for patients who transmit at least 16 calendar days’ worth of device readings. 

CPT 99457 is for spending a minimum of 20 minutes of clinical staff time providing care management services related to patient readings and their treatment plan. Finally, CPT 99458 is used when such clinical staff time reaches 40 minutes, and then a second 99458 can be billed at 60 minutes. These have been the four most common general RPM codes for a few years now.

Assessing the RPM landscape for CPT code additions

However, by 2030, all Baby Boomers will be over 65, meaning alternative care models will need to shift from traditional facilities to the home. This topic of whether to add additional codes to the RPM section was discussed as an agenda item at the May American Medical Association (AMA®) editorial panel meeting. 

Presenters offered additional codes to cover 2 to 15 calendar days of collected and transmitted medical data. CPT 99454, the only current general RPM device supply CPT code, can only be used when a clinician has received and recorded 16 or more days of patient data within a 30-day period. 

The addition of a new code would enable clinicians to code for those 30-day periods where fewer than 16 but at least two readings are captured. 

The second noteworthy change under consideration is a revision of CPT 99457 to include 11-20 minutes of RPM care management time. Code 99457 currently requires at least 20 minutes of recorded care management time. 

Revising 99457 would decrease the amount of time a clinician’s clinical staff needs to provide RPM monitoring and care management for a patient during the month to report the code. 

The third is a revision of CPT 99458 to cover each additional 10 minutes of interactive communication. Code 99458 currently requires at least an additional 20 minutes of interactive communication. Revising 99458 would reduce the amount of additional time clinical staff must spend to report the code. 

RPM updates and revisions paused

While this expansion of RPM codes remains under consideration by the CPT Editorial Panel, the association has continued acknowledging the significant value of remote care management services like RPM. The panel has also expressed a desire to explore how it can further motivate providers to launch programs and help those with existing programs grow them to include more patients. 

Although the AMA and Medicare appear to see the value in well-crafted remote monitoring programs, it was decided at the conclusion of the May meeting to postpone all updates and revisions at this time. Discussions will resume once further information and documentation can be provided to the committee for consideration of these changes as part of an ongoing effort to expand the parts of RPM that work while starting to campaign against those who skirt around or abuse the codes. 

IMO Health will continue to attend and monitor the RPM updates from the AMA, as we know providing patient care, whether it be in person or remote, requires the appropriate content be available in the electronic health record (EHR).  

Want to brush up on your CPT code knowledge? Check out our comprehensive guide here.