2023 Medicare RPM Reimbursement Updates

RPM is the Medicare program for remotely monitoring patients’ vitals, and there are several billing codes associated with it. While there were no major changes to RPM rules and regulations in CMS’ 2023 Final Rule, there are updated reimbursement rates for the CPT codes. 

The CPT codes for RPM are broken down into two categories: device-based and time-based. The first device-based CPT code, 99453, is for the initial device setup where the device is given to the patient and proper usage is explained. This code can be billed once per device. The second device-based CPT code, 99454, is for daily device use and monitoring. A patient must take at least 16 daily device readings per month to trigger this code. This code can only be billed once per month, regardless of how many devices the patient is using. 

The time-based RPM codes are 99457 and 99458. Code 99457 is for at least 20 minutes of non-face-to-face RPM services per month performed by clinical staff, while code 99458 is an add-on code for an additional 20 minutes of RPM services. It can be billed an unlimited amount of times per calendar month. 

For rural health clinics and federally qualified health centers, they cannot bill for RPM with the previously mentioned codes. Instead, they must utilize a more general CPT code, often applied to chronic care management, which is G0511.