Remote Patient Monitoring (RPM) has many benefits for both providers and patients:

• Improved health outcomes
• More engaged patients
• Better day-to-day visibility of patient conditions
• Strong doctor-patient relationship
• Reduced hospital admissions and re-admissions
• Reimbursable, proactive care
• Faster clinical decision making

RPM services can be ordered by physicians and other qualified healthcare professionals (QHCPs).

Clinical staff can deliver and furnish RPM services under general supervision of the billing provider.

The average reimbursements for the four primary CTP Remote Patient Monitoring Codes:

99453: Initial setup and patient education for the use of monitoring equipment.
$19 (one-time)

99454: Supply of device and daily recordings and transmission of data from the patient device.
$56 (monthly)

99457: Treatment management services requiring interactive communication with the patient/caregiver during the month. First 20 minutes per month
$50 (monthly)

99458: Treatment management services requiring interactive communication with the patient/caregiver during the month. Each additional 20 minutes per month.
$41 (monthly)

99453: Initial Enrollment
Only billed upon the initiation of a new RPM program.
Patient consent (verbal or written) is given prior to initiating RPM services.
RPM program is initiated by a Qualified Healthcare Professional (QHCP)

99454: Device Reimbursement and On-Going Data Transmission
On-going billed every 30 days
Device must meet the definition of a Medical Device according to Section 201(h) of the Federal Food, Drug, and Cosmetic Act.
16 days of data per 30-day monitoring period are required

99457: First 20 Minutes of Evaluation and Management
On-going billed every 30 days
E/M services furnished by QHCP or clinical staff under general supervision
This is the first 20 minutes per 30-day monitoring period
A live interaction must occur with the patient or caregiver

99458: Each Additional 20 Minutes of Evaluation and Management
On-going billed every 30 days (up to two instances)
E/M services furnished by QHCP or clinical staff under general supervision
Each additional 20 minutes per 30-day monitoring period
A live interaction must occur with the patient or caregiver

Original Medicare beneficiaries should expect a copay until their deductible is met and then 20% coinsurance of the Medicare-approved costs for service applies for RPM services. The co-insurance is often covered by secondary or supplemental insurance for Medicare beneficiaries.

Private payers may implement their own policies for co-payment and co-insurance for RPM services.

No, over half of all state Medicaid Programs reimburse for RPM, but the requirements, restrictions, and reimbursements vary by state. Increasingly, private payers are reimbursing for Remote Patient Monitoring, but this too varies by payer and region.

Devices used for RPM must meet the FDA’s definition of a “Medical Device” according to Section 201(h) of the Federal Food, Drug, and Cosmetic Act. While it must meet the definition, there is no requirement that the device be Cleared or Approved by the FDA.

To qualify for CPT Code 99454 the device must automatically transmit data via Cellular or Bluetooth connection. Manual data entry from the patient does not qualify for that reimbursement. 16 days of transmitted data are required per 30-day monitoring period.

Currently we integrate with Omrom for blood pressure monitoring. FreeStyle Libre and Dexcom are the current device integrations for continuous glucose monitoring.

Patients can enter manual readings to provide more data to their healthcare providers and team. However, manual data entries from patients do not qualify towards the required 16 days for CTP Code 99454.

In Modo Bio’s platform, all data entries are labeled with the data source (Patient or Device) to ensure the providers and caregivers have a clear understanding of the source of the data.

CMS clarified that patients could receive RPM services for both chronic and acute conditions. The physiologic data that are being monitored must assist with assessment, treatment, or diagnosis of the patient’s condition.

Yes, RPM can be used for new and existing patients. However, patients must give consent (verbal or written) prior to being enrolled in an RPM program.

Some of the most common disease states to track are:

• Hypertension
• Diabetes
• Obesity
• Heart Conditions

Qualified healthcare providers and clinical staff can use the Modo Bio web-based platform to manage their RPM programs and patients.

Patients use a mobile application to sync their device, store their data, and manage their team.

Modo Bio is not a managed service, merely a platform to facilitate data transmission and RPM services for practices and healthcare providers.

RPM falls under the broader umbrella of telehealth. RPM is a unique technology that enhances a healthcare provider’s ability to assess a patient’s current condition, which falls under the broader umbrella of telehealth. Telehealth encompasses the larger industry and enablement of remote care, with the most common use case being two-way video communication.