If you are a Primary Care Physician, the details of billing codes bore you. Physicians are not trained to think in the same way CMS thinks about it. Yet, it is important to know about the billing codes because it will help during the time of the audit. Remote Patient Monitoring CPT code 99453 has some unique requirements. In this blog post, we will discuss the requirements of 99453 in further detail.

What is 99453?

99453 is a new CMS reimbursement code for the Remote Patient Monitoring program. The official determination from CMS is as follows:

CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, Glucose, Heart rate), initial; set-up, and patient education on the use of equipment.”

How does Remote Patient Monitoring CPT Code work?

The code talks about the set-up and education of the equipment. CMS does not reimburse for the equipment itself, only for the time involved in the set-up. The reimbursement for this service is around – $20.50.

Amount of compensation 

As you might have noticed, the reimbursement amount for 99453 is not very high. There are also more constraints. This code can be used only once for the patient’s life cycle with the practice. Once the practice uses code 99453 for a patient, the code cannot be under the same NPI for the same patient.

So why would Primary Care Practices want to use 99453 at all? the answer is simple – it is useful for Enrolling. After Enrollment, monthly service codes are applicable. Some of them are:

99454 – Transmission of data

99457 & 99458 – Review and Management Codes

Enrollment in Remote patient monitoring program 

Enrollment is another need for delivering the Remote Patient Monitoring program. As this is not a walk-in service but a monthly service, patients have to give appropriate consent. Consent documentation has the following topics:

• The qualifying conditions that make them eligible
• The scope of services and their involvement
• The appropriate cost-sharing
• Cancellation process if determined necessary

The consent can be verbal or written form. The written consent is ideal because there is concrete documentation. Verbal consent is easier.

After enrollment, the monthly service can begin.

How does AstuteDoc recommend using 99453 with Enrollment?

We recommend bundling 99453 and enrolling the patient at the same time. This way Primary Care Practices can maximize their efficiency.

In the AstuteDoc software, we provide very specific functionality to enroll the patient.

• • Before enrolling the patient – we provide a simple mechanism to register the device to a patient
  • Our enrollment process provides the option for verbal or written consent
  • For verbal consent, we provide the appropriate call scripts
  • We ensure the consent creates appropriate documentation in the report
  • We ensure Enrollment also generated the appropriate Remote Patient Monitoring billing code in the billing statement.

We hope Primary Care Practices found this blog post on 99453 useful. If you have any further questions, please feel free to contact us and we will be happy to answer any questions.