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Monitoring coding

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As most providers know, three new codes went into effect on January 1, 2019. If you are not taking advantage of them in your RPM program, you should be. 

Code 99453 covers the set-up of devices in an episode of care and patient education, while code 99454 covers the cost of the device(s) with daily recording(s) or programmed alert(s) and can be billed each 30 days. 

Code 99454 covers the actual devices uses by the patient, which supply daily biometric recordings and transmissions or program alerts and transmissions, and this can be billed every 30 days. This CPT code offers reimbursement for providing the patient with a device as defined by the FDA.  We believe CMS may further define the device definition, but it currently remains very broad. 

Code 99457 covers the first 20 minutes for each calendar month of remote physiologic monitoring treatment management services, and of clinical staff/physician/other qualified healthcare professional time requiring interactive communication with the patient/caregiver during the month. But what about all the extra time these healthcare professionals spend working with patients participating in RPM programs? You know it happens. 

The good news is CMS began paying for CPT code 99458 on January 1, 2020. The new code covers each additional 20 minutes (each calendar month) spent on treatment management services.  Use 99458 in conjunction with 99457, which is a far more realistic reflection of what is required to properly manage an RPM program. Providers must remember, however, to bill against code 99457 for the first 20 minute time segment each month and do not report either of these codes for a time segment of fewer than 20 minutes.