Physicians who use remote patient monitoring (RPM) services in Medicare must meet compliance and billing standards, reiterates the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS).
RPM can include both remote physiological monitoring – for example, blood pressure, heart rate, and weight levels – and remote therapeutic monitoring, such as therapy adherence, pain levels, and respiratory status.
A 2024 report conducted by OIG found approximately 43% of patients who received RPM between 2019 and 2022 did not receive all three required components: enrollee education and device setup, device supply, and treatment management, though RPM services grew by more than 10 times during that same period.
Currently, the Centers for Medicare and Medicaid Services (CMS) does not require physicians to bill for all three components; however, physicians must still provide and document all three to be compliant with OIG’s rules.
For example, to satisfy all three components to RPM, a physician who uses it to monitor the condition of a patient with high blood pressure must: ask for the patient’s consent and then supply an internet-connected blood pressure cuff; educate the patient on how to set up and use the cuff to collect data, such as the patient’s blood pressure readings; and use the transmitted data to inform their treatment decisions.
Although the 2024 report’s data is not new, oversight of RPM in Medicare continues to be a priority for OIG. Last year, the agency called for CMS to ramp up oversight of RPM, and CMS agreed. However, in its report, OIG acknowledged Medicare lacked key information for oversight, including data on which physicians ordered monitoring for patients and what diseases or conditions were being monitored.
Per HHS, physicians offering RPM services must have an established relationship with the patient and must be eligible to furnish evaluation and management services. To provide and bill for RPM in Medicare, a physician’s patient must have a chronic or acute condition that requires monitoring; use an internet-connected device approved by the Food and Drug Administration that collects and transmits health data every 16 to 30 days; and their physician must collect patient consent at the time RPM is furnished.
Texas Medical Association staff recommend physicians using RPM to confirm they are appropriately documenting and billing for the service. Physicians who bill Medicare for RPM services must use procedure codes 999453 – 99091, which cover one of three components to RPM. Medicare pays separately for the three components and pays each component at the same rate, regardless of the type of device used or the health data collected, TMA billing staff explain.
TMA’s free Physician Payment Resource Center (PPRC) can assist physicians with RPM documentation and billing questions. PPRC staff also meet directly with Medicare to discuss payment issues, including those related to RPM.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469