Guide to Remote Patient Monitoring & Chronic Care Management Reimbursement

Navigating the complicated world of remote patient monitoring and chronic care management reimbursement can be a complicated task. Luckily 90Health has pulled together the best information available to current CMS reimbursement. Read on to learn how to grow a profitable care management program this year.

Medicare reimbursement for remote patient monitoring:

  • 99453: Initial patient consult for setting up a connected health device. $19 in reimbursement.
  • 99454: 16 or more days of monthly patient physiological data collection. $69 in reimbursement.
  • 99457: First 20 minutes of review of physiological data by clinician - requires brief patient encounter. $54 in reimbursement
  • 99458: Additional 20 minutes of review of physiological data by clinician - requires brief patient encounter. $43 in reimbursement.
  • 99091: 30 minutes of clinician review of RPM data per month. This does not require interaction or consultation with the patient. $58 in reimbursement

Medicare Reimbursement for Chronic Care Management CPT Codes:

  • 99490: 20 minutes of clinical staff time. Comprehensive care plan established, implemented, revised, or monitored. $43 in reimbursement
  • 99491: 30 minutes of clinical staff time. Comprehensive care plan established, implemented, revised, or monitored. $ 74.26 in reimbursement
  • 99487: 60 minutes of clinical staff time: Comprehensive care plan established, implemented, revised, or monitored.

What is the difference between billing for chronic care management and remote patient monitoring CPT codes?

  • Providers can only bill for chronic care management when patients meet the following criteria:
    1. Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
    2. Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline
  • For patients meeting the criteria for chronic care management, providers can also bill for additional remote patient monitoring codes
  • Providers can bill for remote patient monitoring CPT codes for any patient, as long as 16 days worth of physiological data (Heart rate, activity, etc) is collected.

Can Nurses Bill for These Services:

Nurses are fully able to review patient remote patient monitoring data, and to follow-up with patients to counsel them on their progress. However, nurses will need to bill under a doctors NPI “as incident to” the provider. The provider will then pay you once they receive reimbursement from CMS.