Less than a year later, CMS unveiled three new RPM codes, 99457, -453, -454, with the official collective title: “Chronic Care Remote Physiologic Monitoring.” Again, the codes do not require telephonic communication with the patient, but rather, as stated in the -454 description, only “interactive communication with the patient/caregiver during the month.” What also needs to be more widely known is that with -453 code, CMS will reimburse providers simply for helping the patient set up and learn how to use any home health device, such as a blood pressure cuff or a pulse oximetry device.

Seizing the opportunity
To get an idea of how much more organizations could be earning with RPM, let’s take a hypothetical example of the 99091 code, which requires 30 minutes a month to collect and interpret physiologic data, such as blood pressure. Thirty minutes a month is not a stretch if the patient is checking their blood pressure once a week and then sending the reading to the physician’s office through their mobile device.

The average reimbursement for 99091 code in 2018 was $58.68, according to the American College of Physicians. So even if a solo practice only wants to monitor a group of 100 patients with hypertension on Medicare, they could still earn an extra $70,416 a year. That’s only 100 patients and doesn’t include other RPM codes that can be billed concurrently, such as the CCM codes if the patient has two or more chronic conditions.

Maximizing this opportunity requires mobile and automation. Data collection and communication should be through the patient’s mobile device using an app that can efficiently collect biometric, objective and subjective data, along with social determinants of health information through short, easy-to-answer surveys that are automatically sent from and then returned to the provider.

To prevent providers from becoming overburdened, the mRPM program needs to be highly structured to a specific condition(s) or clinical event(s) and carefully scheduled so the provider is the information gatekeeper, preventing a data deluge. To ensure safety, patients should always have the opportunity to call the physician directly if they have health concerns.

Further maximizing this opportunity, the non-chronic-care RPM codes could be used for monitoring a wide range of other conditions and health events, such as post-emergency department discharge monitoring, new medication adjustment, high-risk pregnancies and new mother support (for Medicaid beneficiaries), surgical recovery, and many others.

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