Technology

Does Medicare Pay For Remote Patient Monitoring?

Remote patient monitoring (RPM), also better known as remote patient management, is an emerging segment of telehealth or telemedicine. It’s a healthcare delivery method that involves using connected devices and digital technologies to monitor patients and capture their health data, which is transmitted wirelessly to healthcare practitioners.

This highly digitized system allows healthcare providers to monitor their patients and use medical data to offer care recommendations in real-time. RPM can also be utilized inside the hospital, allowing doctors and clinical staff to remotely manage care delivery in sensitive areas like ICU and HDU. In that respect, it provides around-the-clock supervision, backup, and support to on-site medical staff.

According to Bloomberg, the market for remote patient monitoring solutions is already huge and is expected to grow at a CAGR of 23.5 percent to reach $446 billion by 2028. The surge in the valuation is driven primarily by the increased demand for wearables —a segment that has dominated the RPM market —and technological advancements like the Internet of Things (IoT) and Artificial Intelligence (AI).

Even more fascinating, remote monitoring systems are often used in conjunction with other telehealth methods, such as mobile health, store-and-forward monitoring, and live video. And, at the core of RPM is applying the latest technologies like big data, AI, and data analytics to gather and process patient data outside of traditional healthcare environments.

The benefits of RPM for patients and healthcare providers are equally huge and impressive:

  • Faster and more hassle-free access to healthcare
  • Daily assurance and increased peace of mind for the patient
  • Enhanced quality of care
  • Improved patient feedback, education, and support
  • Patients have a more significant say and influence on their own care and well-being
  • Detailed info on personalized health
  • Improved emergency care

As digital health companies continue to improve their RPM solutions, even more benefits will be enjoyed by patients and clinicians alike. But someone has to pay for RPM services, which begs the question: is remote patient monitoring covered by Medicare?

Medicare Coverage of Remote Patient Monitoring

Let’s start with the burning question on everyone’s mind. Does Medicare cover remote patient monitoring? The answer to this frequently asked question is a resounding yes; Medicare offers coverage for remote patient monitoring services.

But not all RPM services are covered by Medicare.

When it comes to reimbursements, Medicare covers only specific remote patient monitoring services, which are collectively part of “Medicare Telehealth Services.” In most cases, these are RPM services that healthcare providers deliver via live video. On the contrary, store-and-forward delivered services are not covered by Medicare, with the exception of Center for Medicare Services (CMS) telehealth demonstration programs in select states such as Hawaii and Alaska.

Note that Medicare reimburses for other specific kinds of RPM services that may not be regarded as Medicare Telehealth Services. 

Medicare CPT Reimbursement Codes for Remote Patient Monitoring

The specific RPM services eligible for Medicare reimbursements are identifiable by their Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes. The Department of Health and Human Services (HHS) reviews and admits new RPM services upon CMS approval.

The following groups are permitted to send new submissions for review by the HHS:

  • Registered advocacy groups
  • Healthcare providers
  • Other interested parties like community leaders

The CMS will consider the approval of a new RPM service for Medicare reimbursement if it meets the requirements in at least one of the following three categories:

Category #1 – This category covers RPM services that are similar to existing healthcare services like doctor’s office visits, professional consultation, and psychiatry services

Category #2 – This category entails services that aren’t similar to currently approved Medicare Telehealth Services. They will be considered based on whether they offer any demonstrated medical benefits to target patients.

Category #3 – This is a newly admitted category that provides coverage for RPM and other telehealth services that can offer clinical benefits to patients, yet there’s a lack of demonstrated medical evidence as per Category #1 and #2. The category has seen significant action during the Covid-19 pandemic.

You can find an up-to-date list of currently approved CPT codes eligible for Medicare coverage. The CMS updates the index on an ongoing basis, so be sure to check back often.

Which Providers are Covered?

Medicare has numerous restrictions when it comes to claiming reimbursement for remote patient monitoring services. One of these restrictions applies to the type of healthcare providers who can deliver Medicare-eligible RPM services. They include:

  • Certified registered nurse anesthetists
  • Clinical nurse specialists
  • Nurse-midwives
  • Physicians and their assistants
  • Nutrition professionals
  • Registered dietitians 
  • Nurse practitioners
  • Clinical social workers
  • Clinical psychologists

Note that clinical social workers and clinical psychologists are not allowed to bill for RPM-delivered psychotherapy services, including medical management and evaluation services.

Geographical Restrictions

Originating site refers to the patient’s location at the time they receive care services via remote patient monitoring. As part of telehealth, Medicare considers RPM almost wholly as a healthcare assistive tool for remote and rural areas.

Telehealth service eligibility for Medicare reimbursement is almost exclusively restricted to originating sites in an HPSA (Health Professional Shortage Area). You’re also eligible if the originating site is in a county outside of any US Census Bureau’s Metropolitan Statistical Area (MSA).

Which Healthcare Facilities are Eligible?

On top of the geographical restrictions, Medicare also restricts where the patient is seeking the RPM services. Facilities that are eligible for Medicare reimbursement include:

  • Rural emergency hospitals
  • Critical access renal dialysis centers
  • Community mental health facilities
  • Skilled nursing facilities
  • Federally qualified health facilities
  • Rural health clinics
  • Critical access hospitals
  • Hospitals 
  • Healthcare provider offices

There are several exceptions to these geographical and facility restrictions. For example, you can be allowed to seek reimbursement for RPM-delivered end-stage renal disease services. The same goes for treating acute stroke, mental health disorders, co-occurring mental health conditions, and substance abuse disorders.

Medicare and Remote Chronic Care Management & Monitoring

CMS created back in 2015 a dedicated CPT code for chronic care management, allowing for reimbursement for services received through non-one-on-one consultation. RPM-delivered chronic care management services fall under this code.

Conclusion

Remote patient monitoring is a game-changer in the world of telehealth, as it facilitates better, faster, and more hassle-free access to healthcare. That’s why it comes as a massive reprieve that Medicare covers services received via RPM solutions.

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