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Supported Line of Business: Medicare Advantage

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Overview

Remote Patient Monitoring (RPM) services were established by CMS through the CY 2019–2020 Physician Fee Schedule (PFS) Final Rules and became billable beginning January 1, 2019, with expanded coding and clarification in 2020. RPM services are designed to support Medicare patients with acute or chronic conditions by collecting and analyzing physiologic data digitally and using that data to manage and coordinate care between visits.

RPM services involve the use of FDA-defined medical devices that automatically collect and transmit physiologic data (e.g., blood pressure, weight, pulse oximetry, glucose readings) to the billing practitioner. These services may be furnished by clinical staff as incident-to services under general supervision, with the billing practitioner responsible for oversight, medical decision-making, and care plan integration.

There are no standalone National or Local Coverage Determinations (NCDs/LCDs) specific to RPM - coverage and requirements are governed primarily through the annual PFS final rules and the Medicare Benefit Policy Manual.

To qualify for RPM, a patient must:

• Have an acute or chronic condition that warrants ongoing monitoring, and
• Use an FDA-defined medical device that automatically uploads/transmits physiologic data, and
• Meet minimum data transmission requirements (≥ 16 days of readings in a 30-day period for treatment management codes).

There are several components of RPM services, each billed separately when requirements are met:

1. RPM Device Setup & Patient Education

   Covers initial device setup and patient instruction on use.

2. RPM Device Supply & Data Transmission

   Covers provision of the device and collection/transmission of physiologic data over a 30-day period (minimum data requirements apply).

3. RPM Treatment Management (20 minutes per month)

   Requires at least 20 minutes of clinical staff, physician, or other qualified health care professional time in a calendar month reviewing data, managing treatment, and communicating with the patient or caregiver.

4. Additional RPM Treatment Management Time

   May be billed in additional time increments when monthly time thresholds beyond the base requirement are met.

All RPM services must meet CMS requirements for:

• Documented medical necessity
• Interactive communication with the patient or caregiver (real-time, synchronous communication)
• Accurate time tracking for treatment management services
• Use of a qualifying medical device
• Integration of monitoring into the patient’s overall care plan