Remote Patient Monitoring Toolkit

Understanding RPM

This toolkit is intended to give a broad overview of Remote Patient Monitoring (RPM) for both patients and providers. A shortened version of this toolkit can be downloaded here. Feel free to contact us at [email protected] with any questions about this toolkit or with any additional questions about RPM.

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Remote Patient Monitoring Basics

What is Remote Patient Monitoring?

Remote patient monitoring (RPM) technology lets providers use devices to capture health data from their patients remotely without a face-to-face appointment or in-person testing. RPM technology allows patients to be monitored outside clinical settings, such as at home or other remote locations. RPM can be vital for managing chronic conditions such as hypertension, type 2 diabetes, and asthma. The information gathered through RPM technology can help providers better understand their patient’s health and take actionable steps to treat and manage their conditions.

What different types of RPM are there?

Remote patient monitoring (RPM) devices collect patient data outside traditional healthcare settings and transmit that data to healthcare providers for analysis. There are many different types of RPM devices, each designed to monitor specific aspects of a patient's health. Here are some of the most common RPM devices:

Blood pressure monitors: These devices measure a patient's blood pressure and can be used to monitor hypertension or other cardiovascular conditions.
Glucose monitors: These devices measure a patient's blood sugar levels and can be used to monitor diabetes.
ECG monitors: These devices record a patient's heart rhythm and can be used to monitor for arrhythmias or other heart conditions.
Pulse oximeters: These devices measure a patient's oxygen saturation levels and can be used to monitor for respiratory conditions or sleep apnea.
Weight scales: These devices measure a patient's weight and can be used to monitor for obesity or other conditions that may affect weight.
Thermometers: These devices measure a patient's body temperature and can be used to monitor for fever or other signs of infection.
Activity trackers: These devices monitor a patient's physical activity, such as steps taken or distance walked, and can be used to monitor for conditions that may be affected by physical activity, such as obesity or cardiovascular disease.

RPM devices may be used in conjunction with mobile apps or online portals that allow patients to view and track their health data and communicate with their healthcare providers. This can help patients better understand their health and make more informed decisions about their care.

Remote patient monitoring (RPM) vs. remote therapeutic monitoring (RTM)

Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are two related but distinct types of patient monitoring used in healthcare. While both technologies involve remote monitoring devices, they are designed to address different aspects of healthcare delivery.

RPM is focused on monitoring patients' health status outside of traditional healthcare settings, such as the home, and transmitting that data to healthcare providers for analysis. RPM devices can monitor various health parameters, including blood pressure, glucose levels, heart rate, oxygen saturation, weight, etc. RPM is typically used for patients with chronic conditions or requiring ongoing monitoring.

RTM is focused on non-physiologic data. This can include tracking patients' adherence to prescribed medications and treatments. RTM devices monitor medication usage, dosages, and timing and track patients' response to medications or other therapies. RTM is typically used for patients who require ongoing medication management.

While RPM and RTM involve remote monitoring devices, they differ in their goals and applications. RPM is focused on providing healthcare providers with real-time patient health status data, allowing for early detection and intervention in the event of a health crisis. RTM is focused on ensuring that patients adhere to prescribed treatments and medications, helping to improve treatment outcomes and reduce healthcare costs. RPM and RTM are valuable tools for improving healthcare delivery, but they address different aspects of patient care.

It should be noted that billing codes for RPM and RTM are distinct – because RPM is a more clinical method of patient monitoring, RPM codes are considered evaluation/management and can only be billed by physicians or qualified healthcare providers. RTM codes are general medical codes primarily billed by physical therapists and generally cover a broader range of services

RPM and Health Apps

Health applications for mobile devices are an increasingly significant part of the current healthcare landscape. More than 350,000 different health apps today help manage everything from fitness and sleep to specific chronic conditions. These apps can also be used with RPM devices to manage patient health when relevant. There are a wide variety of uses that health apps can have when used together with RPM devices – a few examples are listed below.

Data Tracking and Monitoring

Health apps can be used to track and monitor various health data points, such as blood pressure, heart rate, glucose levels, and more. The RPM devices can collect this data and transmit it to the health app, which can then be used to track and monitor the patient's health over time.

Alerts and Notifications

RPM devices can be programmed to send alerts and notifications to the health app if specific health metrics fall outside a predetermined range. The health app can then alert the patient or healthcare provider to respond to immediate needs or adjust their treatment plan accordingly.

Communication and Collaboration

Health apps can also facilitate communication and collaboration between patients and healthcare providers. RPM devices can transmit health data to the health app, which can then be shared with healthcare providers for review and analysis. Healthcare providers can then communicate with patients through the app to provide feedback, answer questions, and adjust the patient's treatment plan as needed.

When used correctly, health apps can help to improve patient outcomes by providing real-time data tracking and monitoring, timely alerts and notifications, and enhanced communication and collaboration between patients and healthcare providers.

Benefits and Challenges of Remote Patient Monitoring

What are some benefits of RPM?

Improved Patient Outcomes

The usage of RPM is proven to improve patient outcomes. By monitoring patient health consistently, healthcare professionals can identify potential health issues early and take necessary corrective measures before they become serious. Using RPM can reduce the likelihood of complications and improve overall patient health.

Increased Efficiency

RPM can increase the efficiency of healthcare delivery. Physicians can reduce the number of in-person visits by remotely monitoring patients, freeing up provider time and resources. RPM can also lead to reduced wait times and faster patient care access.

Cost Savings

Remote patient monitoring can lead to cost savings for patients by reducing the need for in-office visits and costly medical interventions. Patients can also benefit from reduced associated costs on in-office visits, such as transportation and childcare, leading to greater overall care affordability.

Enhanced Patient Engagement

The use of RPM devices can improve patient engagement and overall health literacy. RPM can lead to greater patient clarity and understanding of their health and provide the tools and information they need to take an active role in their care.

Real-Time Monitoring

Because of the nature of RPM devices, healthcare professionals can monitor patient health in real time. Providers can better understand a patient’s condition in all areas of their life, not just what they can observe in the office. RPM can be especially beneficial for patients with chronic conditions, as physicians can more effectively adjust treatment plans to reflect their condition.

What are some challenges of RPM?

Technical Challenges

RPM devices can be complex and require existing technical expertise to install, set up, and maintain. Technical challenges can include connectivity, device malfunctions, and data management issues. Healthcare providers must ensure that they have the technical infrastructure and expertise to support RPM and that patients receive adequate device use and troubleshooting training.

Patient Engagement

RPM requires active patient participation in the monitoring process, which can be challenging for some patients, particularly those with limited health literacy, cognitive impairment, or other barriers to engagement. Healthcare providers must work to ensure that patients understand the purpose of RPM and have the skills and resources necessary to participate actively in their care. Patients who are not digitally literate may also struggle to utilize devices to their full potential. This issue may be more pronounced in populations generally less experienced with technology, such as older adults.

Integration with Existing Workflows

Integrating RPM into existing clinical workflows can be challenging and requires coordination between healthcare providers, patients, and support staff. Healthcare providers must ensure that RPM is seamlessly integrated into existing workflows and that data from RPM devices are easily accessible and actionable.

Data Overload

RPM generates a large amount of data, which can overwhelm healthcare providers and patients. Healthcare providers should ensure that data is collected and analyzed in a meaningful and actionable way and that patients have the tools and resources necessary to understand and act on their own data.

Cost

RPM devices and services can be expensive, particularly for patients without insurance coverage or those with limited financial resources. If RPM is not utilized deliberately, existing inequities in healthcare may be reproduced again in RPM usage. Healthcare providers must work to ensure that RPM services are affordable and that patients have access to the necessary resources and support.

Remote Patient Monitoring Billing

Basics of RPM Billing

It is important to note that billing for RPM services may be complex and require additional documentation, such as a physician's order and a patient's consent to receive the service. Healthcare providers should follow all regulations and guidelines when providing RPM services and billing.

Federal Billing - Medicare

Medicare uses “remote physiologic monitoring” in its coding and billing language. The following Medicare payment policies must also be followed.

Patient and provider must have an “established patient-provider relationship” – this requirement has been suspended for the duration of PHE but is expected to come back into effect after the PHE as of May 11, 2023
Consent to receive RPM services must be obtained from the patient
The billing practioner must be eligible to furnish evaluation and management services (E/M)

The primary CPT codes that are covered for RPM billing under Medicare:

CPT Code	Brief Description
99453	Initial setup of the remote monitoring device and educating the patient on how to use it, including connecting it to other devices, if needed.
99454	Monthly remote monitoring with daily electronic recordings of physiological data from the patient. At a minimum, a provider must receive RPM recordings for 16 days during the 30-day period in which services are billed.
99457	Remote patient monitoring treatment & management that includes dialogue between the clinical staff and patient and lasts at least 20 minutes, billed per calendar month.
99458	Each additional 20 minutes of patient monitoring treatment & management services provided, billed per calendar month.
99091	Clinical providers can bill for the time spent collecting, interpreting, and processing physiological data from patients. Patients must receive RPM services for at least 30 minutes every 30 days. This does not require interactive communication with patients.

See the 2023 Physician Fee Schedule for more information about telehealth codes and reimbursement rates.

It should be noted that patients do not need to be diagnosed with a chronic condition to utilize RPM devices or to be billed with the above codes. It should also be noted that if a more specific code is available to be billed, that code should be used.

Two examples of more specific service RPM codes include:

Self-Monitored Blood Pressure (SMBP) Codes: 99473, 99474
Continuous Glucose Monitoring Codes: 95249, 95250, 95251

State-by-State Billing - Medicare

State Medicaid does not cover RPM in every state – nearly half of the states currently do not offer reimbursement for RPM devices and services. As of September 2022, all four states in the UMTRC region (Illinois, Indiana, Michigan, and Ohio) have some measure of RPM coverage, though some of this coverage is very limited.

For more information, see the state sections below – for specific coverage questions or clarification, it is recommended to contact the state offices of Medicaid directly.

Illinois

Illinois defines remote patient monitoring (RPM) as “the use of connected digital technologies or mobile medical devices to collect medical and other health data from a patient at one location and electronically transmit that data to a health care professional or facility at a different location for collection and interpretation.”

Currently, RPM coverage by Illinois Medicaid is relatively narrow – Illinois will specifically cover device costs for at-home uterine monitoring and continuous glucose monitors (CGMs) under certain circumstances. Currently, there is no broader coverage of RPM Services within Illinois.

According to the most recent version of the Practioner Fee Schedule, the following general RPM codes are covered by Illinois Medicaid:

CPT Code	Brief Description
99091	Clinical providers can bill for the time spent collecting, interpreting, and processing physiological data from patients. Patients must receive RPM services for at least 30 minutes every 30 days. This does not require interactive communication with patients.

Specific Service RPM Codes Covered:

Continuous Glucose Monitoring Codes: 95249, 95250, 95251

Indiana

The most recently available guidance from Indiana Medicaid states that “The Indiana Health Care Program (IHCP) has implemented a single RPM coverage and prior authorization policy to be used for fee-for-service (FFS) and managed care delivery systems.”

Indiana Medicaid has a relatively broad range of RPM coverage, covering the same general RPM codes as Medicare. According to the most recently available guidance, the following general RPM codes are covered by Indiana Medicaid:

CPT Code	Brief Description
99453	Initial setup of the remote monitoring device and educating the patient on how to use it, including connecting it to other devices, if needed.
99454	Monthly remote monitoring with daily electronic recordings of physiological data from the patient. At a minimum, a provider must receive RPM recordings for 16 days during the 30-day period in which services are billed.
99457	Remote patient monitoring treatment & management that includes dialogue between the clinical staff and patient and lasts at least 20 minutes, billed per calendar month.
99458	Each additional 20 minutes of patient monitoring treatment & management services provided, billed per calendar month.
99091	Clinical providers can bill for the time spent collecting, interpreting, and processing physiological data from patients. Patients must receive RPM services for at least 30 minutes every 30 days. This does not require interactive communication with patients.

Specific Service RPM Codes Covered:

Self-Monitored Blood Pressure (SMBP) Codes: 99473, 99474

According to Indiana Medicaid guidance:

“The remote patient monitoring (RPM) telehealth services in this [list] must be billed with POS code 02 or 10 and modifier 95. Check the IHCP Professional Fee Schedule to determine if prior authorization (PA) is required for the procedure code. See the Telehealth and Virtual Services module for PA documentation requirements and medical criteria.”

For specific information on what these cover and the circumstances they should be utilized, see the current Telehealth and Virtual Services Codes provided by the Indiana Health Coverage Programs (IHCP).

Michigan

According to Michigan Medicaid, “Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a health care provider in a different location for assessment and recommendations.”

At this time, Michigan covers the following general RPM codes:

CPT Code	Brief Description
99453	Initial setup of the remote monitoring device and educating the patient on how to use it, including connecting it to other devices, if needed.
99454	Monthly remote monitoring with daily electronic recordings of physiological data from the patient. At a minimum, a provider must receive RPM recordings for 16 days during the 30-day period in which services are billed.
99457	Remote patient monitoring treatment & management that includes dialogue between the clinical staff and patient and lasts at least 20 minutes, billed per calendar month.
99458	Each additional 20 minutes of patient monitoring treatment & management services provided, billed per calendar month.

Specific Service RPM Codes Covered:

Self-Monitored Blood Pressure (SMBP) Codes: 99473, 99474

Continuous Glucose Monitoring Codes: 95249, 95250

See the list of covered Michigan Medicaid Telemedicine Codes for more information.

Michigan also explicitly requires that devices used for RPM “must meet the U.S. Food & Drug Administration (FDA) definition of a medical device.” Michigan Medicaid does not consider “Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records” medical devices. They are not covered as RPM devices.

Ohio

Remote Patient Monitoring (RPM) is covered under the Ohio Medicaid definition of telehealth as one of the explicitly allowed versions of telehealth. Ohio Medicaid covers the following RPM codes:

CPT Code	Brief Description
99453	Initial setup of the remote monitoring device and educating the patient on how to use it, including connecting it to other devices, if needed.
99454	Monthly remote monitoring with daily electronic recordings of physiological data from the patient. At a minimum, a provider must receive RPM recordings for 16 days during the 30-day period in which services are billed.
99457	Remote patient monitoring treatment & management that includes dialogue between the clinical staff and patient and lasts at least 20 minutes, billed per calendar month.
99458	Each additional 20 minutes of patient monitoring treatment & management services provided, billed per calendar month.

Specific Service RPM Codes Covered:

Self-Monitored Blood Pressure (SMBP) Codes: 99473

Private Payer

RPM services can also be billed to private insurance companies. Each insurer may have billing requirements and codes, so checking with the specific insurer when billing is essential.

Direct Pay

If services are not covered by insurance, patients may pay out-of-pocket for RPM services, and the healthcare provider can charge a fee. The fee can be based on the time spent providing the service, the complexity of the service, and the type of device used.

More Information about Remote Patient Monitoring

RPM Vendors

The UMTRC does not endorse or sponsor specific vendors for RPM or other telehealth products. However, you can find a list of a few sample vendors of RPM devices and platforms below:

There is a wide range of RPM vendors providing different service levels to clients – we recommend consulting our Technology Resource Center or vendors themselves with specific questions.

RPM Podcasts

Check out a few of our podcast episodes about RPM!

RPM and Telehealth with Shuo Qiao

Danielle speaks with Shuo Qiao from Moving Analytics about remote cardiac rehabilitation. Tune in to discuss emerging healthcare technology and how to use data to inform important healthcare decisions.

Remote Patient Monitoring with Mark Russell and Janson Lanier

Danielle speaks with Mark Russell and Janson Lanier from Vitalograph about Remote Patient Monitoring (RPM) and Respiratory Diagnostics. Tune in for an overview of specialty RPM devices and a discussion of how they can be used to monitor chronic and acute conditions.

Remote Patient Monitoring with Bernard (Bernie) Benassa

Danielle and Cam speak with Bernard Benassa about Remote Patient Monitoring (RPM) in part one of this special two-part episode. Bernard has extensive experience in the RPM Industry and a wide range of knowledge of RPM Devices and their implementation. Tune in for part one, where Bernard gives an overview of RPM Devices and looks at how they can be applied in telehealth.

More Questions? Contact us at [email protected]

This toolkit is intended to be informational, not to guide care or coverage decisions. For specific questions, we recommend you contact your physician or insurance provider.

Last Updated Mar 1, 2023