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RPM leverages FDA-cleared devices to continuously collect and transmit patient physiological data, including vital signs like blood pressure, heart rate, glucose levels, and weight. It enables timely medical intervention and reduces hospital admissions through proactive patient management.
CCM services involve coordinated care for Medicare patients managing two or more chronic conditions expected to persist at least 12 months. It covers extensive care coordination beyond standard office visits, significantly enhancing patient care and reducing healthcare costs.
Note: 99453 and 99454 billing requires data collection for at least 16 days within each 30-day period.
Yes, RPM (99457) and CCM (99490) can be billed together if distinct time requirements (at least 20 minutes each) are met separately within the same month, totaling at least 40 minutes.
RPM devices must be FDA-cleared and capable of automatic physiological data transmission, such as:
RPM CPT codes 99457 and 99458 can be billed under "general supervision," allowing qualified clinical staff to deliver services under the indirect oversight of the billing practitioner. Compliance with state-specific licensing laws is required.
These codes are billable once per patient, per 30-day period, regardless of the number of devices used, provided data collection meets the 16-day requirement.
99457 reimburses for the initial 20 minutes of interactive communication each month, requiring documented virtual interaction (video, phone, text, or email).
Time spent by clinical staff and qualified billing professionals directly contributes to these codes.
Managing RPM and CCM billing internally requires meticulous recordkeeping and significant administrative resources. Outsourcing offers significant advantages:
Conclusion
Effectively managing Medicare reimbursement for RPM and CCM involves understanding detailed billing procedures and accurate recordkeeping. Partnering with specialized RPM and CCM billing providers can simplify processes, enhance patient care, improve efficiency, and maximize healthcare revenue.
Consider outsourcing your RPM and CCM billing to streamline operations and elevate your chronic care management practices.
