The Top Things You Need to Know to Bill CPT® Code 99453
- Who Can Order 99453? An ordering provider (a physician or other qualified healthcare provider) can order RPM for the patient. Note: while the patient does not need to have an official diagnosis, the ordering provider should only prescribe an RPM program to a patient if the provider believes the remote physiologic monitoring is medically necessary. Common conditions that are monitored via RPM include: hypertension, diabetes, chronic kidney disease, and congestive heart failure.
- Patients Must Provide Consent to Participate. Once you have the RPM order, the patient must provide consent to participate in the program. Patient consent can be given in writing or verbally and should be documented in the patient’s medical record.
- One-Time Use Code. 99453 is a one-time code and can only be billed once per patient per episode of care. If you provide the patient with two devices at setup or add a second device for the same episode of care, you cannot bill for 99453 twice. An episode of care begins when the patient is enrolled in RPM and ends when the patient’s treatment goals are met. If the patient meets their goals, is discharged from RPM, and later re-enrolled into RPM, you can then bill 99453 for this patient’s new episode of care.
- Patient Setup and Education. To bill for 99453, the patient must be set up and provided with education on how to use a device to take their readings, such as a blood pressure monitor, pulse oximeter, weight scale, glucometer, and others. These devices must meet the FDA definition of a medical device, and we recommend choosing an RPM partner that provides FDA-regulated devices for at-home use. To help the patient with setup and education, it’s best to have someone from your RPM vendor or one of your care team members meet with the patient to help get the device activated, show the patient how it works, and when–and how often–they should take a reading. We recommend that the patient successfully takes their first reading during this session.
- Dependency on 99454 and the 16-Day Requirement. Even once you have the patient setup and educated on how to use their device, you cannot bill for 99453 until the patient has taken 16 days of readings within 30 days, which is the requirement for CPT® code 99454. These readings must be 16 separate days, not 16 readings in total. So, if a patient is provided a device but has not yet met the required 16 days of readings within 30 days for CPT® Code 99454, you cannot yet bill for 99453.
- Reimbursement Rates. The national average reimbursement rate for 99453 is approximately $19.65, but rates will vary by geography and location. Vivo Care does not interpret or define the CMS RPM codes and recommends that you refer to your billing specialist or MAC office for guidance.
Vivo Care’s Best Practices for Meeting CPT® Code 99453 Requirements
- Cellular Devices are Patient Friendly Devices: To drive higher patient adherence, it’s critical to provide easy-to-use devices for your patients so there’s minimal technology barriers. Cellular devices are extremely easy to use and require no setup. For example, a patient using a cellular blood pressure device only has to push one button to take a reading and transmit the data. In contrast, Bluetooth devices require a smart device, mobile app, and internet connection. Pairing, syncing, and updating apps can be challenging for non-tech savvy patients.
- Conduct a Personalized Onboarding Appointment: Whether it’s conducted in-person or remotely, a personalized and interactive conversation is critical for engaging patients with RPM. During the RPM appointment, an RPM expert should show the patient how to use the device, coach them through their first reading, explain their RPM treatment plan (frequency and timing of readings), and set expectations for ongoing communication with the monitoring team.
- Provide Flexible Onboarding Options: An onboarding event at your office, where your staff has dedicated in-person RPM appointments with new RPM patients, is a great way to engage patients in RPM from Day 1. However, not every patient may be willing or able to attend an in-office visit for RPM. Remote onboarding with direct device shipping can be a great way to boost RPM participation for patients as your RPM program grows.
- Start Daily Monitoring Immediately: While the first reading should be taken during the onboarding appointment, you still need the patient to take 15 more days of readings after the onboarding to meet the 99454 16-day requirement, and bill for 99453. Your clinical monitoring team —whether that is your own staff or your RPM partner’s staff —should start engaging with your patients the day after onboarding to encourage daily readings.