Wiki Remote Patient Monitoring Billing

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I would be interested in the information as well. I have discussed the billing and coding with the company my providers are leaning towards however information from “outside” would be appreciated.
 
I would also like to get more information. Are there certain ICD-10 codes that need to be billed along with these CPT codes? Thanks!
 
We are all looking for the same answers, and no one has been able to assist. I have spent the last three hours Googling this question and am getting nowhere. I need to know what some of the MCAs require for location and modifiers. United Healthcare states they will follow Medicare. BCBS is ambiguous. Oon Wellmed doesn't say anything. The list goes on. Since some of these posts are older, what have you learned about RPM claims billing? I am at a loss, and any guidance would be appreciated. I have the basics, but it is the nuances of various payers I am having difficulty with.
 
There are 4 RPM codes we bill as outpatient / clinic setting services. We provide monitoring for two conditions. Obesity and hypertension. These codes are billed monthly.
Remote Patient Monitoring Codes
99453 one time only - onboarding -
99454 device + 16 days of data collected
99457 monitoring - 20 mn/ month (document time & discussion each day and total at the end of the month)
99458 Each addtl total 20 mn / month (document time & discussion each day and total at the end of the month)

A couple things to watch for: One payer (Medica) denies more than one of these codes on a single date of service - they are in the E/M category therefore *only one E/M code per provider per day* rule applies. We are forced to make individual claims one day apart for this payer. super annoying. Also - codes are for 30 day increments therefore when you hit the month of Feb (28 days) you have to do some careful planning / coordinating so your billing does not come up short of the day requirement. Finally - some payers deny coverage for obesity (most will cover) and MN Medicaid will not cover the 99458 at all.

Medical provider orders & RN or other qualified staff does the day to day communication w/ patient, documents and bills charges on behalf of the ordering provider. Payments are *meh* but patient success rates for changing behaviors is quite high. Seems to work. what else do you want to know?
 
Any chance anyone know if we could bill CPTs 99453, 99454, 99457 for RPM without supplying a PHYSICAL device? We are supplying a "software" application that requires patient training and account creation that is linked to the device that the patient already owns (we did not provide the device).

Also can we bill 99453 separately if we are not billing 99454 at the same time?

Any insight would help!

Thank you in advance
 
ppaule said:
Any chance anyone know if we could bill CPTs 99453, 99454, 99457 for RPM without supplying a PHYSICAL device? We are supplying a "software" application that requires patient training and account creation that is linked to the device that the patient already owns (we did not provide the device).

Also can we bill 99453 separately if we are not billing 99454 at the same time?

Any insight would help!

Thank you in advance
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Hi there, does the patient's device meet the code's requirement?

To report remote physiological monitoring, the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional.
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beckysblouin said:
/There are 4 RPM codes we bill as outpatient / clinic setting services. We provide monitoring for two conditions. Obesity and hypertension. These codes are billed monthly.
Remote Patient Monitoring Codes
99453 one time only - onboarding -
99454 device + 16 days of data collected
99457 monitoring - 20 mn/ month (document time & discussion each day and total at the end of the month)
99458 Each addtl total 20 mn / month (document time & discussion each day and total at the end of the month)

A couple things to watch for: One payer (Medica) denies more than one of these codes on a single date of service - they are in the E/M category therefore *only one E/M code per provider per day* rule applies. We are forced to make individual claims one day apart for this payer. super annoying. Also - codes are for 30 day increments therefore when you hit the month of Feb (28 days) you have to do some careful planning / coordinating so your billing does not come up short of the day requirement. Finally - some payers deny coverage for obesity (most will cover) and MN Medicaid will not cover the 99458 at all.

Medical provider orders & RN or other qualified staff does the day to day communication w/ patient, documents and bills charges on behalf of the ordering provider. Payments are *meh* but patient success rates for changing behaviors is quite high. Seems to work. what else do you want to know?
Click to expand...
Thank you. this was very helpful. The practice I work for messed up when it came to February they kept pushing the date and now they are billing 10/13/2023 as the read date of the report for the month of September. I don't see how they could bill the 99454 so far into the next month for the previous month. Can they do that? Due to documentation purposes, If the RPM reports says read 09/30/2023 and they billed it 10/13/2023. Is that Fraud?
 
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