Maximizing Reimbursement and Patient Outcomes with RPM and CCM

Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) are two powerful tools that healthcare providers can use to provide high-quality care to patients with chronic conditions. RPM allows healthcare providers to remotely monitor patients' health status with connected medical devices in between doctor’s visits or following a hospital stay, while CCM provides comprehensive care coordination and management for patients with two or more chronic conditions.

The Centers for Medicare and Medicaid Services (CMS) recognizes RPM and CCM as complementary services, meaning that providers can bill for these services concurrently. In this blog, we’ll review RPM codes and CCM codes, and explain how providers can maximize reimbursements from Medicare (and Medicaid in some states) for both RPM and CCM activity.

Remote Patient Monitoring Overview

Remote Patient Monitoring CPT codes were first introduced in 2019 to reimburse healthcare providers for the remote collection and interpretation of physiologic data like blood pressure and blood sugar.

Today, the codes are as follows, with reimbursement amounts reflecting 2023 non-facility national averages.

99453
This one-time code covers initial setup and patient education and training on use of the device.
Reimbursement amount: $19.32 one time

99454
This code pays for supplying the device for daily recording. Unlike 99453, 99454 can be billed monthly as long as the patient uses the device for at least 16 days during a 30-day billing period. This can only be billed once per patient per month, even if the patient has more than one connected device.
Reimbursement amount: $50.15 per patient, per month

99457
This code covers the first 20 minutes of clinical staff monitoring, care coordination and physician-patient communication. Interactive communication must contribute to the 20 minutes, but it is not the only activity that can be included.
Reimbursement amount: $48.80 per patient, per month

99458
Each additional 20 minutes of clinical staff monitoring and communication is covered by this code (billed in conjunction with 99457).
Reimbursement amount: $39.65 per patient, per month

99091
This covers the collection and interpretation of remote data by a physician or Qualified Health Professional, not general clinical staff.
Reimbursement amount: $54.22 per patient, per month

A few restrictions do apply to RPM codes:

• RPM codes cannot be billed in the same period as continuous glucose monitoring (CPT 95250) or blood pressure self-monitoring codes (CPT 99473). However, RPM CAN be billed in conjunction with CGM code 95251.
• Currently, Federally Qualified Health Centers and Rural Health Clinics are not permitted to bill for RPM.

Chronic Care Management Overview

Chronic Care Management services are non face-to-face services for Medicare beneficiaries who have two or more chronic conditions. This includes clinical care coordination and referrals to other providers, prescription management, and ongoing review of the patient’s status.
In 2015, CMS first introduced CPT codes to reimburse healthcare providers for CCM services. Today, the codes are as follows, with reimbursement amounts reflecting 2023 non-facility national averages.

99490
This code is for 20 minutes over a 30-day period of providing non-complex, non-face-to-face time monitoring a patient’s care plan. This can be time spent by clinical staff under the direction of a physician.
Reimbursement amount: $62.69 per patient, per month

99439
This code accounts for each additional 20 minutes of clinical staff time spent providing non-complex CCM. (billed in conjunction with 99490)
Reimbursement amount: $47.44 per patient, per month

99487
This code covers complex CCM, defined in CMS guidelines as patients with two or more conditions who require “moderate or high complexity medical decision making.” This code reimburses for 60 minutes of time spent by clinical staff to revise or establish comprehensive care plans.
Reimbursement amount: $133.18 per patient, per month

99489
This code accounts for each additional 30 minutes of complex CCM (reported in conjunction with 99487, cannot be billed with 99490)
Reimbursement amount: $70.49 per patient per month

99491
CCM services provided directly by a physician for at least 30 minutes.
Reimbursement amount: $85.06 per patient, per month

Unlike RPM, Federally Qualified Health Centers and Rural Health Clinics are able to bill for CCM services.

Billing for RPM and CCM Concurrently

Many patients who meet the criteria for CCM—two or more chronic conditions—could benefit from RPM as well to help manage their chronic conditions between in-person doctor’s visits. CMS does permit providers to bill CCM and RPM for one patient as long as the criteria for both have been met in full. For example, billing RPM code 99457 and CCM code 99490 requires a provider to provide at least 40 minutes of services—20 minutes of RPM and 20 minutes of CCM.

Using the non-facility national averages, providers could receive reimbursement of at least $161.64 per patient, per month for patients with two or more chronic conditions.
Initiating RPM and CCM programs can feel overwhelming, but the benefits to a physician practice are substantial—both financially and clinically. Experience with these types of codes and care delivery models will help prepare healthcare leaders for a value-based future.

Rimidi’s Clinical Management Platform for RPM and CCM

Rimidi’s Clinical Management Platform was built to support both RPM and CCM, by combining patient-generated health data from connected devices or patient reported outcomes measures with clinical data from the EHR to drive patient-specific clinical insights and actions through embedded clinical decision support cards. The Rimidi platform not only provides a way to capture time for billable activity, but offers CCM care plan templates, and full exportable reports for billing and audit.