Wiki Remote Patient Monitoring - 99453 / 99454 / 99457 / 99458

[ppaule]

Hi,

I am having difficulties finding resources regarding RPM billing and coding.

First question, I was hoping to clarify if we could bill 99453/ 99454 for a “software” called Monitair. It’s a software that registers data from CPAP machines. It requires for the providers to set up an account and train the patients for usage. We were unsure if we could use 99453/99454 because there is no physical device that we are supplying. The device is already owned by the patient.

99453 – Initial set up of Monitair / training
99454 – For the supply of “software” and daily recordings

Second question, if the software does not qualify as a device under 99454, can we still bill 99453 for the set up and training?

Lastly, would you say we could bill separately for 99457/99458 for the treatment management services with data coming from this specific “software”? For the purpose of billing for the provider/patient interaction regarding the course of treatment?

Any tips we could do to find the right guidance in billing these codes? We have yet to contact the payers for specific guidelines, but this is on our list of to-dos!

Thank you in advance!

Precilla

 

[CBLENNIE]

I don't know if commercial payers will cover RPM services related to CPAP machines but per CMS LCA A52467 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea - Policy Article CMS specifically states that there is not benefit or payment to DMEPOS suppliers for remote monitoring services. I don't know if you are a DMEPOS provider but if so Medicare will not pay for these services. The LCA doesn't indicate if there is any restriction on coverage and payment of RPM services for a CPAP.

If you look at the definition of 99453 it is intended to be used with an FDA approved RPM device which I don't think would include a CPAP.