Medicare Reimbursement for Remote Monitoring in 2023
The CY 2023 Physician Fee Schedule Final Rule, which contains 2,953 pages of policy changes, was released on November 1, 2022, and the RPM reimbursement rates were discussed in this article.
The American Medical Association (AMA) predicts a shortage of physicians, ranging from 37,800 to 124,000 by 2034, and suggests that telehealth and technology could help alleviate the burden.
Remote patient monitoring is an effective tool for reducing practitioners' workload, but accessible technology is essential. Hence, it is necessary to know how to choose the most effective outsourced remote patient monitoring services for your healthcare partners in 2023.
Essential insights on Medicare Reimbursement for 2023
Updates for 2023 Medicare reimbursement rates in RPM include changes to Medicare RPM reimbursement rates and CPT codes. CMS has made it easier for healthcare providers to adopt remote patient monitoring since 2019. CMS is expected to update RPM reimbursement rates and CPT codes yearly.
However, for 2023, the Proposed Rule RPM G codes were not added to the final rule. Therefore, the two key takeaways for 2023 Medicare reimbursement rates for remote patient monitoring are:-
- Medicare reimbursement rates were updated for 2023.
- RPM CPT codes for 2023 remain unchanged: 99453, 99454, 99457, 99458, and 99091.
Let’s check the CPT codes for 2023, including the average reimbursement rate and requirements.
Medicare Reimbursement Rates for RPM CPT Codes
In 2023, Medicare reimbursement rates for RPM services will be available through the below CPT codes.
CPT Code 99453: Medicare 2023 Remote Patient Monitoring (RPM)
This code reimburses for the initial setup and patient education of remote patient monitoring equipment for vital signs such as blood pressure, pulse oximetry, blood glucose, respiratory flow rate, and weight.
It can be billed once following the first 16 days of monitoring. The national average payment rate for CPT 99453 is $19.
CPT Code 99454: Medicare 2023 RPM Daily Recording or Programmed Alert
This code pays for daily recording or programmed alert transmissions from remote patient monitoring equipment and can be billed multiple times if the patient uses the device for at least 16 days per month.
It can be billed every 30 days. The national average payment rate for CPT 99454 is $49.
CPT Code 99457: Medicare 2023 RPM Treatment Management Reimbursement
This code covers the initial 20 minutes of treatment management, including interactive remote communication with the patient through video call, phone call,, email, or text messaging.
It is billed under general supervision and allows healthcare organizations to contract third-party remote patient monitoring companies to assist with RPM services. The national average payment rate for CPT 99457 is $48.
CPT Code 99458: Medicare 2023 RPM Additional Treatment Management Reimbursement
This code covers each additional 20 minutes of RPM services, up to a maximum of 60 minutes per month, and requires documentation of how the time is distributed. The national average payment rate for CPT 99458 is $39.
CPT Code 99091: Medicare 2023 RPM Clinical Staff Time Reimbursement
This code reimburses for a minimum of 30 minutes of clinical staff time per calendar month spent on gathering, interpreting, and processing data transmitted by a patient.
It includes at least one communication by phone or email where medical management or monitor advising occurs. The national average payment rate for CPT 99091 is $53.
Outsourcing RPM Services for Medicare Reimbursement
With projected physician shortages, the AMA suggests that remote patient monitoring can help reduce the burden on practitioners, provided the technology is accessible. Outsourcing RPM services can help healthcare organizations
- Increase patient volume,
- Drive better patient engagement, and
- Generate more revenue.
However, not all RPM programs are equal, and healthcare partners should look for software and services that meet their specific needs.
The following section provides tips and suggestions for identifying the best third-party remote patient monitoring companies for telehealth and chronic management.
What to consider when looking for RPM Partnership services
The required outsourcing level is a crucial starting point when reviewing remote patient monitoring outsourcing companies. Depending on the healthcare practice's needs, various pricing structures are available, ranging from full-service models to basic-service models
Full-service models can cover tasks such as
- FDA-cleared device setup
- Patient Education
- HIPAA-compliant technical support
- Data review
- Patient interaction
- Device shipping/fulfillment
In contrast, basic service models typically only cover device setup and patient education, leaving physicians responsible for data review and patient interaction.
While a basic service model may yield a higher Return On Investment (ROI), it may also increase physicians' workload.
Considering all costs associated with physicians' time, including housing and shipping devices to patients, onboarding patients, and ongoing HIPAA-compliant technical support is essential.
Additionally, healthcare organizations must ensure a smooth integration of devices and software into their Electronic Health Record Systems (EHRs) and have reliable ongoing technical support.
To take advantage of 2023 Medicare reimbursements for Remote Patient Monitoring, a full-service model with a top-notch remote patient services company may be worth the investment.
Remote Patient Monitoring from Vozo
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