2020 CMS Code Updates: Remote Patient Management (RPM)

December 11, 2019

CMS have finalized significant changes related to RPM which is great news for the providers who need more time monitoring and managing their patient's condition outside of the practice.

Orb Health

Centers for Medicare and Medicaid Services (CMS) have finalized significant changes related to Remote Patient Monitoring (RPM) which is great news for the providers who need more time monitoring and managing their patient’s condition outside of the practice. More patient monitoring outside of a clinical setting will increase patient access and in turn lower healthcare cost. 

In 2020, RPM Codes 99457 and 99458 may be furnished under general supervision, which is a huge benefit from the 2019 requirement of direct supervision. This will now allow providers the options to outsource with a team who will monitor patients and work incident to the billing provider. If any issues are to arise with the patient they would be directed to their provider. 

  • CPT code 99457 (Remote patient monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes)  
  • 99457: $51.63 
  • CPT code 99458 (Remote patient monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes). 
  • 99458: $42.23 (up to twice a month) 

RPM mimics the requirements of CCM to include an additional 20 minutes code (99458) for those patients that require more contact for the month. This code may be used two times, per month, per patient.  

RHCs and FQHCs are not separately billable due to the fact that they are included in the RHC All Inclusive Rate (AIR) and Prospective Payment System (PPS) payment. We hope this will be re-evaluated in future rulemaking.  

In addition to the above changes, CMS has also stated that moving forward in 2020 a single annual consent for services will be obtained. The changes coming to us with the New Year show great promise and the accessibility to our patient population is vital. All patients will find benefit with RPM.