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Preventing denials of RPM and related services


First Coast Service Options Inc. (First Coast) wants to ensure you avoid common denials related to "Remote physiologic monitoring (RPM)", RPM treatment management and digitally stored data services. 

These services are relatively new and have specific coding requirements that must be strictly followed to prevent denials and reduce appeal delays.

Let's look at each type of service.

RPM services:

Report these services using the following Current Procedural Terminology (CPT®) codes,
  • CPT code 99453 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on use of equipment
    • Used to report the setup and education of the device
  • CPT code 99454 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
    • Used to report supplying the device for the monitoring
Collection and interpretation of the remotely captured data only (without treatment or management) is reported with CPT code 99091

For RPM treatment and management services, use CPT code 99457

RPM limitations:
  • Do not report these codes in conjunction with codes for more specific physiologic parameters [e.g., CPT code 93296 (implantable, insertable, and wearable cardiac device evaluations), CPT code 94760 (measure blood oxygen level)]
  • May not be reported when provided with other monitoring services (e.g., CPT 95250 for continuous glucose monitoring)
Additional points of consideration:
  • Do not report CPT codes 94002-94004 (ventilator management codes) in conjunction with these services
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