Q&A: Reporting 2019 CPT codes for remote patient monitoring services

Q: What is the difference between CPT code 99091 (collection and interpretation of physiologic data digitally stored or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation [when applicable], requiring a minimum of 30 minutes of time, each 30 days) and new remote patient monitoring codes 99453-99454 (remote monitoring of physiologic parameter[s]) and 99457 (remote physiologic monitoring treatment management services)?

A: The code description for 99091 doesn’t include all the necessary components to describe how remote patient monitoring services are furnished using current technology and staffing models.

As a result, for 2019, the American Medical Association introduced three new codes for remote patient monitoring services:

• 99453, remote monitoring of physiologic parameter(s), initial; setup and patient education on use of equipment
• 99454, remote monitoring of physiologic parameter(s), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
• 99457, remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

These codes more accurately reflect contemporary remote patient monitoring services and are separately reimbursable under Medicare.

The decision to allow separate reimbursement for code 99453 for remote monitoring of physiologic parameters may incentivize providers to start using these technologies with their patients. CMS’ vision is to promote new technologies with separate payment for the initial setup of equipment and education for new patients.

Code 99454 represents the initial 30 days of daily recordings for physiological parameters such as weight, blood pressure, pulse oximetry, and respiratory flow rate.

Unlike code 99091, which is used to report 30 minutes of remote patient monitoring over the course of 30 days, code 99457 is used to report 20 minutes of remote patient monitoring provided during a calendar month. A physician, a non-physician practitioner (NPP), or clinical staff can report code 99457 as long as the provider interactively communicated with the patient or the patient’s caregiver.

Code 99091 doesn’t explicitly allow for remote monitoring service to be delivered by clinical staff such as registered nurses or medical assistants. In other words, the physicians and NPPs must personally perform and document the full 30 minutes of remote monitoring per 30-day period. This service doesn’t offer additional reimbursement for the onboarding of a new patient with equipment setup and training.

Editor’s note: Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, answered this question during the HCPro webinar, “2019 CPT Update: Prepare for New Coding, Documentation Requirements.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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