The Centers for Medicare & Medicaid (CMS) does reimburse for remote patient monitoring, but there are specific requirements that billing care providers must follow to qualify. In this guide, we explore remote patient monitoring Medicare requirements and the proposed changes that are on the horizon.
CMS Requirements for Remote Patient Monitoring
The CMS remote patient monitoring fact sheet lists the following billing and payment requirements for RPM services:
- Billing physicians or clinical staff acting on their behalf must already be eligible to bill Medicare for health services to be able to bill Medicare for remote patient monitoring.
- An established patient-provider relationship must exist prior to starting remote patient monitoring.
- Patients must express consent for participation in remote patient monitoring.
- Health data must be collected and transferred digitally to a secure server that the care team can access.
- Remote patient monitoring systems must use monitoring devices that are FDA-approved, such as those available through TimeDoc Health.
- The monitored conditions must be either acute or chronic.
- Data must be collected for at least 16 days over a 30 day period.
- Billing must be submitted using the proper remote patient monitoring CPT codes. RPM typically falls under the following CPT codes: 99453, 99454, 99457, 99458, and G0511.
Implement TimeDoc Health’s device, software, and personnel solutions to ensure your RPM systems are compliant with CMS regulations.
Does CMS Reimburse for Telemedicine?
CMS reimburses for telemedicine because these services are essential for effectively managing time-sensitive health conditions and providing increased access to health services for marginalized communities. As a subset of telemedicine, CMS telehealth documentation requirements also detail steps for remote patient monitoring reimbursement.
What Is the CMS Proposed Rule 2024 Telehealth?
The 2024 CMS proposed rule is designed to empower patients and providers to leverage remote patient monitoring and other telehealth methods for proactive care. Central to the proposed rule are new CMS telehealth billing guidelines for rural health clinics (RHCs) and federally qualified health centers (FQHCs), which would include:
- Extending reimbursement for telehealth services (including RPM) through the end of 2024.
- Including RPM services within code G0511, simplifying their inclusion with virtual care plans.
- Flexible pay rate calculations to better account for the frequency of telehealth services provided.
You can learn more in our guide to the 2024 CMS proposed rule.
Remote Patient Monitoring Reimbursement: Medicare-Approved RPM with TimeDoc Health
As a care provider, both patient outcomes and operational efficiency are top priorities. With TimeDoc Health, you can streamline RPM services, management, and billing to achieve each of these goals. With TimeDoc Health, your team can benefit from:
- Compliance with FDA medical device requirements
- Products and services that are eligible under CPT codes
- Automatic, real-time data updates that connect to your existing EHR system
- Customizable alert settings
- Expert care coordinators to support your team as you scale RPM services
See how a centralized RPM platform can transform your RPM system. Schedule a demo today.
