CPT Codes and billing
As telehealth continues to be a fundamental aspect of patient care, it’s crucial for healthcare providers to achieve appropriate reimbursement to ensure the financial stability and profitability of the practice. Qardio’s online billing resources and reimbursement experts can help you understand what codes your practice may be eligible to bill for, and assist you in making revenue and cost projections for a new RPM program.
With our turnkey RPM program, we’ll even help by generating claims for relevant CPT codes for each patient, which will simplify and streamline your billing processes.
What are CPT codes?
CPT (Current Procedural Terminology) codes are standardized codes used by healthcare providers, including doctors, to describe medical services and procedures they perform. They provide a uniform language system for healthcare providers to describe medical services and procedures, enhancing the reporting process and improving accuracy and efficiency. These codes are widely accepted and used throughout the United States, which help with claims processing and developing medical care review guidelines. The CPT codes help to streamline the reporting and reimbursement process for medical services.
How will CPT codes help your practice?
Reimbursements: CPT codes are used by insurance companies to determine reimbursement for medical services and procedures. Using the correct CPT code helps ensure the practice is paid appropriately for its services.
Record Keeping: CPT codes provide a consistent and standardized way of documenting medical services and procedures, ensuring that accurate and complete medical records are kept.
Data Collection: On healthcare utilization and cost, to allow healthcare professionals to analyze trends and patterns in medical care. To use this data to improve practice efficiency, identify areas for cost savings, and enhance patient care.
Compliance: CPT codes are required by law for Medicare and Medicaid reimbursement and are also a requirement for participation in many private insurance plans. By using CPT codes, a practice can ensure that it is in compliance with these regulations.
Increase accuracy and efficiency: Using a uniform language for coding medical services and procedures, allows for a streamlined reporting process which helps healthcare providers deliver better care and make better use of their time and resources.
How to bill for remote patient monitoring in 2023
With remote monitoring and telehealth services, doctors can monitor patients more frequently and provide more comprehensive care, leading to improved patient outcomes and increased value-based care.
Doctors can also bill for a broader range of services that were not possible to bill for in a traditional in-person visit; this includes:
Remote Patient Monitoring
- 99458, 99457, 99454, 99453
(Under Remote Physiologic Monitoring Treatment Management Services) - 99446- 99449, 99451 & 99452
(Under Interprofessional Telephone/Internet/Electronic Health Record Consultations)
- 99091
(Under Digitally Stored Data and Remote Physiologic Monitoring Services)
Virtual Communication
- HCPCS code G2010 & G2012
Chronic Care Management
- 99490, 99491, 99487 & 99489
(Under Chronic Care Evaluation and Management Services)
Self-Measured BP
- 99473 & 99474
(Under Digitally Stored Data and Remote Physiologic Monitoring Services)
Holter Monitoring
- 93224 & 93227
(Under Cardiovascular Monitoring Services)
Remote Patient Monitoring Example Financial Scenario
The example RPM financial model in the table below presents the potential financials of a hypothetical 1000-patient RPM program under low and high patient adherence scenarios. Please note this is only a hypothetical example, and real-world scenarios differ. To better understand the potential financial dynamics of an RPM program in your practice, please get in touch with our team of RPM reimbursement specialists.
CPT Code Description | CPT Code | Reimbursement | Frequency | Project Annual Revenue | Project Annual Revenue |
|---|---|---|---|---|---|
| Review, interpretation and basic communcation of insights (first 20 minutes) | CPT 99457 | $48.72 | Monthly | $467,712.00 | $555,408.00 |
| Review, interpretation and basic communcation of insights (Additional 20 minutes) | CPT 99458 | $39.65 | Monthly | $333,060.00 | $475,800.00 |
| RPM transmission of 16 days of readings, devices and services | CPT 99454 | $54.10 | Rolling 30 Days | $227,220.00 | $454,440.00 |
| Annual Gross Revenue Opportunity | $1,027,992.00 | $1,485,648.00 | |||
| Estimated Costs | Rate | ||||
| Qardio Platform Access Fee | $47.00 | Monthly | $564,000.00 | $564,000.00 | |
| Patient Monitoring and Claims Generation | $27.00 | Patients with >20 min Monitoring Time | $259,200.00 | $307,800.00 | |
| Annual Yearly Costs | $823,200.00 | $871,800.00 | |||
| Total Yearly Net Profit Opportunity | $204,792.00 | $613,848.00 | |||
*Low adherence scenario assumes 1000 patient program with the following billing frequencies: CPT 99457 80% of potential, CPT 99458 70% of potential, CPT 99454 35% of potential.
*High adherence scenario assumes 1000 patient program with the following billing frequencies: CPT 99457 95% of potential, CPT 99458 100% of potential, CPT 99454 70% of potential.