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Reimbursement

Recent changes have greatly expanded reimbursement for telehealth and Remote Patient Monitoring (RPM). In fact, RPM codes are stackable with CCM and Complex CCM codes, many behavioural health codes and other non-face to face reimbursements within a comprehensive program.

Reimbursement Strategies & Sources of Revenue

The cost of the RxPense Hub, Portal or Care Portal can easily be defrayed, in fact may become a revenue generator over time. Most insurers (Private + Public) in the USA cover telemedicine and remote patient monitoring for those able to bill Medicare, Medicaid or a traditional Payor like an insurance company. While this source of revenue is currently available in the USA, the COVID-19 pandemic has opened the eyes of politicians around the world to better ways of interacting and helping patients.

As of August 2021, CMS in the USA has expanded coverage to even more remote monitoring activities. Recent changes have greatly expanded reimbursement for telehealth and remote patient monitoring. The current billing codes allow for a minimal annual revenue of $2,079 per device, when billing only for RPM services. Add on fees for daily patient measurements and telemedicine and not only is the cost of the RxPense solution covered, but you have opened a new, recurring revenue stream to boost your profit.

Explore the table below to determine the appropriate billing codes which may be applicable in your instance. To download the CMS List of Telehealth Services, complete, or this summary table, click on one of the links, below.

New CPT Codes reimburse for Remote Patient Monitoring

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CPT 99453

$19 ONE-TIME

initial set-up and training on use of equipment

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CPT 99454

$64 MONTHLY

device records data and generates programmed alerts

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CPT 99457

$32-$52 MONTHLY

remote monitoring services with 20 min clinician time

Sample Medicare/Medicaid/(Private Payor) Reimbursement Codes for Telehealth and Remote Patient Monitoring*

Billing Code What it Covers Who Can Bill How Often What Medicare Pays
Telehealth Visits
99202-99205 Telehealth-enabled office or other visits for
new patients
Medicare Part B Providers or
Qualified Health Professionals
Once $73.97 – $224.36
99211-99215 Telehealth-enabled office or other visits for
established patients
Medicare Part B Providers or
Qualified Health Professionals
No limitation $23.03 – $183.19
G0425-27 Telehealth consultations Medicare Part B Providers or
Qualified Health Professionals
No limitation $101.19 – $200.29
G0406-08 Follow-up inpatient telehealth consultations
furnished to beneficiaries in a hospital or SNF
Medicare Part B Providers or
Qualified Health Professionals
No limitation $38.38 – $103.28
Virtual Check-ins
G2010
G2012
A brief (5-10 minutes) check via telephone or
other telecommunications device to decide whether an office visit or other service is needed. It may also include a remote evaluation of recorded video and/or images submitted by an established patient.
Medicare Part B Providers or
Qualified Health Professionals
No limitation $12.21
$14.66
e-visits
99421-423 Patient-initiated communications between an
established patient and their provider through a HIPAA-compliant secure platform.
Medicare Part B Providers or
Qualified Health Professionals that can bill for E/M services.
Once during a 7-day
period
$15.00 – $47.46
Remote Patient Monitoring
99091 The collection and interpretation of physiologic
data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the
physician or other qualified health care professional. In this instance, a QHP is qualified by education, training, licensure/regulation (when applicable). The code requires a minimum of 30 minutes of interpretation and review.
To bill for CPT Code 99091, the
initial provider service must occur in the physician’s office or other applicable sites. Additionally, only a physician or QHP may perform these services, distinguishing it significantly from 99457, in which a clinical staff member can provide services “incident to.”
Once in a 30-day
billing period.
$56.88
99453 The initial set-up of devices, training, and
education on the use of monitoring equipment and any services needed to enroll the patient on-site.
Not specified; not required to be
clinical staff (Practice Expense
Only Code)
Once per patient,
only first month of reading for 99454
$19.19
99454 The supply and provisioning of devices used for
RPM programs.
Not specified; not required to be
clinical staff (Practice Expense
Only Code)
Once in a 30-day
billing period; required 16 days of readings
$63.16
99457 The remote monitoring of physiologic data as
part of the patient’s treatment management services. To receive reimbursement, the physician, QHP, or other clinical staff must provide RPM treatment management services for at least 20 minutes per month.
Those in indirect general
supervision of clinical staff
Once per month $50.94
99458 Each additional 20 minutes of remote
monitoring and treatment management services provided.
Those in indirect general
supervision of clinical staff
Once per month $41.17
Chronic Care Management

99490

99487

The first full 20 minutes of non-complex Chronic Care Management of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
• Multiple (2 or more) chronic conditions expected to last at least 12 months or until the death of the patient;
• Chronic conditions place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline;
• Comprehensive care plan established, implemented, revised, or monitored.
Medicare Part B Providers or
Qualified Health Professionals
Once per month $91.77
99487 The first 60 minutes of clinical staff or QHP or provider time for moderately or highly complex CCM. Medicare Part B Providers or Qualified Health Professionals Once per month $41.17
99489 An additional 30 minutes of time spent in the same billing cycle as 99487 with high or moderate complexity patients who require more time. Medicare Part B Providers or
Qualified Health Professionals
Once per month $43.97
Principal Care Management
G2064 An interaction between a physician or non- physician practitioner with a patient with one chronic disease or high-risk condition lasting at least 30 minutes per calendar month. Medicare Part B Providers or
Qualified Health Professionals
Once per month $90.37
G2065 An interaction between clinical staff with a patient with one chronic disease or high-risk condition lasting at least 30 minutes per calendar month. Medicare Part B Providers or
Qualified Health Professionals
Once per month $38.73
Transition Care Management
99495 Transitional Care Management services,
including interactive contact with the moderately complex patient within two days of discharge, with a face-to-face visit within 14 days of discharge.
Medicare Part B Providers or
Qualified Health Professionals
Once per discharge $207.96
99496 Extra care incentives for highly complex
patients with interactive contact within two days of discharge for TCM services, with a face- to-face visit within seven (7) days of discharge.
Medicare Part B Providers or
Qualified Health Professionals
Once per discharge $281.59

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