Vianova’s Remote Patient Monitoring (RPM): Billing and Best Practices for CPT Code 99453

Remote Patient Monitoring (RPM) has become an essential tool for healthcare providers to monitor patients’ health remotely, especially for chronic conditions such as hypertension, diabetes, chronic kidney disease, and congestive heart failure. To bill for RPM services, providers use specific Current Procedural Terminology (CPT) codes, with CPT code 99453 being one of the primary codes used for initial patient setup and education. Here are the top things you need to know to bill CPT code 99453, with a focus on Vianova, a leading RPM provider.

1. Who Can Order 99453? RPM services can be ordered by an ordering provider, which includes physicians or other qualified healthcare providers. The provider should only prescribe an RPM program to a patient if they believe it is medically necessary, although an official diagnosis is not required.
2. Patients Must Provide Consent to Participate. Before billing for CPT code 99453, the patient must provide consent to participate in the RPM program. This consent can be given in writing or verbally and should be documented in the patient’s medical record.
3. One-Time Use Code. CPT code 99453 is a one-time use code, which means it can only be billed once per patient per episode of care. Even if the patient is provided with multiple devices or added to the RPM program multiple times, this code can only be billed once per episode of care. An episode of care starts when the patient is enrolled in RPM and ends when the patient’s treatment goals are met. If the patient is discharged from RPM and later re-enrolled, then CPT code 99453 can be billed for the new episode of care.
4. Patient Setup and Education. To bill for CPT code 99453, the patient must be set up and educated on how to use the RPM device, such as a blood pressure monitor, pulse oximeter, weight scale, glucometer, or other FDA-regulated medical devices. It is recommended to choose an RPM partner, such as Vianova, that provides patient-friendly cellular devices for easy and convenient use. It is also important to have an RPM expert or a member of the care team meet with the patient to activate the device, demonstrate its use, and guide the patient on when and how often to take readings. It is recommended that the patient successfully takes their first reading during this session.
5. Dependency on 99454 and the 16-Day Requirement. CPT code 99453 cannot be billed until the patient has taken 16 days of readings within a 30-day period, which is the requirement for CPT code 99454. These readings must be on 16 separate days, not just 16 readings in total. If the patient has not yet met this requirement, CPT code 99453 cannot be billed.
6. Reimbursement Rates. The national average reimbursement rate for CPT code 99453 is approximately $18, but rates may vary by geography and location. It is important to refer to your billing specialist or Medicare Administrative Contractor (MAC) office for guidance on interpreting and defining CMS RPM codes.

Best Practices for Meeting CPT Code 99453 Requirements with Vianova

Vianova, as an RPM provider, recommends the following best practices to maximize patient engagement and participation in the RPM program:

1. Provide Patient-Friendly Cellular Devices: Cellular devices are easy to use and require minimal setup, making them ideal for maximizing patient adherence. For example, Vianova’s cellular blood pressure device only requires the patient to push one button to take a reading and transmit the data,taken during the personalized onboarding appointment. It’s important to encourage patients to start taking daily readings immediately after setup. This helps patients establish a routine and get accustomed to using the device regularly. Remind patients about the importance of consistent monitoring and how it can help them achieve their treatment goals.
2. Offer Ongoing Support and Communication: Keeping patients engaged in the RPM program requires ongoing support and communication. Regularly check in with patients to address any questions or concerns they may have about using the device or interpreting their readings. Provide education and reinforcement on the importance of monitoring their health parameters regularly. Utilize telehealth or remote communication methods to stay connected with patients and provide timely feedback and guidance.
3. Document Consent and Education: Proper documentation is essential for billing CPT code 99453. Ensure that patient consent to participate in the RPM program is documented in their medical record, including the method of consent (written or verbal) and the date it was obtained. Document the details of the personalized onboarding appointment, including the device used, readings taken, and education provided. This documentation serves as evidence of medical necessity and supports reimbursement for RPM services.
4. Stay Compliant with Billing Guidelines: To ensure proper reimbursement, it’s crucial to stay compliant with billing guidelines for CPT code 99453. This includes meeting the requirement of 16 days of patient data transmission within 30 days for CPT code 99454 before billing for 99453. Avoid double billing for 99453 within the same episode of care, and only bill for it once per patient per episode of care. Stay updated with the reimbursement rates for your geography and location and consult with billing specialists or MAC office for guidance on billing practices.

In conclusion, CPT code 99453 is an important code for remote patient monitoring (RPM) services, covering the initial patient setup and education. Providers need to ensure that patients provide consent, receive proper education on device usage, and meet the requirement of 16 days of patient data transmission before billing for 99453. Following best practices, such as using patient-friendly devices, conducting personalized onboarding appointments, providing ongoing support, and maintaining proper documentation, can help maximize patient engagement, compliance, and reimbursement for RPM services. Stay compliant with billing guidelines and consult with billing specialists for accurate billing practices.

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