Billing for remote patient monitoring
Learn about policies and reimbursement for remote patient monitoring (RPM).
On this page:
What remote patient monitoring services are billable?
RPM includes both remote physiological monitoring and remote therapeutic monitoring.
- Remote physiologic monitoring involves the use of non-face-to-face technology to monitor and analyze a patient's physiological metrics. Examples of physiological metrics include oxygen saturation, blood pressure, blood sugar or blood oxygen levels, weight loss or gain.
- Remote therapeutic monitoring (RTM) captures non-physiologic data related to a therapeutic treatment. This includes data on a patient’s musculoskeletal or respiratory system. RTM can also monitor treatment adherence (e.g., medication compliance) and treatment response (e.g., pain management). Information is transmitted using a connected medical device.
Both remote physiologic monitoring and remote therapeutic monitoring data can be transmitted electronically; however, only RTM data can be self-reported by the patient using the device.
Medicare
Medicare reimburses for both remote physiological monitoring and RTM.
Requirements for RPM include:
- Remote physiologic monitoring, but not RTM, requires an established patient relationship.
- Remote physiologic monitoring service must monitor an acute or chronic condition.
- Remote physiologic monitoring must be collected for at least 16 days out of 30 days.
- 16-day data collection in a 30-day period does not apply to treatment management codes 99457, 99458, 98980, and 98981.
- Only one practitioner can bill for RPM per patient in a 30-day period.
- Remote physiologic monitoring and RTM cannot be billed together.
- Monitoring must be medically reasonable and necessary.
- Remote physiologic monitoring and RTM, but not both, may be billed concurrently with the following care management services for the same patient as long as time and effort are not counted twice: chronic care management (CCM), transitional care management (TCM), behavioral health integration (BHI), principal care management (PCM), chronic pain management (CPM).
- For global periods of surgery, remote physiologic monitoring and RTM may be billed by practitioners that are not receiving the global service payment.
- Patient consent is required at the time RPM is furnished.
- Physiologic data must be electronically collected and automatically uploaded to a secure location where the data can be available for analysis and interpretation by the billing practitioner.
- The device used to collect and transmit the data must meet the definition of a medical device as defined by the FDA.
- The services may be provided by health care personnel under the general supervision of the billing practitioner.
Medicare policies for telehealth continue to evolve. For the latest information, view the Medicare Physician Fee Schedule. The following Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are frequently used to bill for RPM services. Coding guidance is subject to change.
| CPT/HCPCs code | Description | Time | Audio- only coverage | Permanent coverage for telehealth |
|---|---|---|---|---|
| 99091 | Monthly review of data | 30 min | N/A | No |
| 99453 | RPM device set up | N/A | N/A | No |
| 99454 | Monthly review of RPM data | 16 or more days over a 30 day period | N/A | No |
| 99457 | Patient-provider communication related to RPM data | 20 min | Yes | No |
| 99458 | Patient-provider communication related to RPM data | Additional 20 min | Yes | No |
| 98975 | RTM device set up and patient education | N/A | N/A | No |
| 98976 | RTM monitoring, respiratory | 16 or more days over a 30 day period | N/A | No |
| 98977 | RTM monitoring, musculoskeletal | 16 days or more over a 30 day period | N/A | No |
| 98980 | Patient-provider communication related to therapeutic device | 20 min | Yes | No |
| 98981 | Additional time required for 98975-98978 or 90980 | Additional 20 min | Yes | No |
Medicaid
Each state has its own billing and reimbursement policies. For tips on Medicaid policies, visit Medicaid and Medicare RPM.
Private insurance
Find out if the patient has private insurance. If so, check with the patient's insurance company for information on their billing and reimbursement policies. For tips on private insurance policies, look up policy by jurisdiction .
Safety net providers
RPM services are billable. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can receive a separate payment for these services.
Requirements include:
- An established patient relationship
- Patient consent at the time RPM is furnished
- Must be medically reasonable and necessary
- Must not be duplicative
Tip: Read more about billing Medicare for telehealth services as a safety net provider.
More information:
Leveraging Remote Patient Monitoring in Your Practice (PDF) — Health Resources and Services Administration
Billing and payment policies for telehealth services to treat chronic conditions — Health Resources and Services Administration
Medicare Learning Network: Chronic Care Management Services — Centers for Medicare & Medicaid Services
Telehealth for Providers: What You Need to Know (PDF) — Centers for Medicare & Medicaid Services
Remote Patient Monitoring Policy — National Telehealth Policy Resource Center