The American College of Rheumatology provides ACR and ARP members with key resources and tools to navigate the ever-changing landscape of coding, documentation, billing and practice guidelines. Visit the ACR’s practice support pages for more tools you and your practice team. Information provided by our coding experts is copyrighted by the ACR and intended for individual practice use only.
Remote physiologic monitoring (RPM) treatment management codes were created to report services that are provided when clinical staff utilize the results of remote monitoring devices to manage a patient under a specific treatment plan. These services are a general telehealth option classified under the evaluation and management (E/M) services to collect and analyze patient vitals on an ongoing basis between regular office visits and can only be furnished by a physician, other qualified healthcare professional or clinical staff under the general supervision of physician (eligible to bill for Medicare E/M services). These services are part of a monthly billable program and track patients’ health issues/status which:
- Must be for an established patient, one with whom the physician has had a prior new patient E/M service. This E/M service is allowed to be done via telehealth; and
- Allow for both chronic and acute conditions.
RPM can be performed through the transmission of multiple clinical data devices, such as weight scales, blood pressure monitors, pulse oximeters, glucometers, heart rate monitors, thermometers and spirometers.
The two general RPM Current Procedural Terminology (CPT) codes are:
|First 20 minutes of physician’s interpretation and interactive communication with the patient/caregiver every month.
|Subsequent 20 minutes of physician’s interpretation and interactive communication with the patient/caregiver every month.
Note: “Interactive communication” involves a minimum of real-time synchronous, two-way audio interaction that is capable of being enhanced with video or any other kind of data transmission. Additionally, the 20 minutes for both 99457 and 99458 includes both synchronous, real-time interactions as well as face-to-face care management services.
Activities that Contribute to Clinical Monitoring
In general, any time spent monitoring patient data or communicating with patients regarding their health status can be counted towards billing 99457 and 99458, including:
- Monitoring and analyzing patient data;
- Sending any patient communication inline with HIPAA guidelines (text, phone, video);
- Providing ongoing patient education or communicating patient updates and escalations;
- Reviewing patient’s readings with other care team members or other providers; and
- Making changes to patient’s care plan medications.
Documentation is a very important element when billing and coding RPM services, as with other services. Clinical staff must spend a minimum of 20 minutes in a calendar month conducting the monitoring activities. In addition, the clinical staff must have at least one live or synchronous, two-way, interactive call with the patient. To qualify as synchronous communication, this must be at minimum a live phone call or video call. Text messages and/or voicemails do not meet the interactive call requirement. If you met 20 minutes of care time but did not conduct a live conversation with the patient, CPT code 99457 should not be billed.