Healthcare Insights
Top remote patient monitoring codes for diabetes patients
Since the beginning of the COVID-19 pandemic, the use of remote patient monitoring (RPM) has skyrocketed across multiple sectors of the healthcare industry. Thanks to RPM technology, patients with chronic conditions like diabetes can keep tabs on their health without booking an appointment with their provider.
What is remote patient monitoring?
Remote patient monitoring is a form of telehealth in which a provider collects and monitors a patient's physiologic data remotely using electronic devices. Aspects of a patient’s health that a provider might monitor remotely include heart rate, blood pressure, blood oxygen level, weight, and neurological activity, among others.
RPM benefits both patients and providers as it allows patients to collect their own health data. As a result, providers can spend less time conducting the tests and more time analyzing and acting on a patient’s results. Additionally, RPM can reduce the risk of infection to staff and patients.
Using data from the Definitive Healthcare Atlas All-Payor Claims dataset, we've compiled a list of the top remote patient monitoring CPT codes ranked by their percentage of total RPM services received by diabetes patients in 2023. Data represents claims for the year 2023 through September.
| Rank | CPT code | CPT code description | % of total RPM services received by diabetes patients | Explore dataset |
|---|---|---|---|---|
| 1 | 99457 | Remote physiologic monitoring, 1st 20 min./month | 32.10% | Explore |
| 2 | 99454 | Remote physiologic monitoring, init. supply of device | 26.00% | Explore |
| 3 | 99458 | Remote physiologic monitoring, additional 20 min./month | 19.20% | Explore |
| 4 | 99453 | Remote physiologic monitoring, init. setup and patient education | 11.10% | Explore |
| 5 | 98980 | Remote therapeutic monitoring, Tx mgmt., init. 20 min./month | 2.90% | Explore |
| 6 | 98977 | Remote therapeutic monitoring, supply of device for musculoskeletal system status | 2.90% | Explore |
| 7 | 98975 | Remote therapeutic monitoring, init. setup and patient education | 2.20% | Explore |
| 8 | 99091 | Collection and interpretation of physiologic data, 30 min. | 2.20% | Explore |
| 9 | 98981 | Remote therapeutic monitoring, Tx mgmt., additional 20 min./month | 1.10% | Explore |
| 10 | 98976 | Remote therapeutic monitoring, supply of device for respiratory system status | 0.20% | Explore |
Fig. 1. Data from the Definitive Healthcare’s Atlas All-Payor Claims dataset for the calendar year 2023 through September. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Accessed November 2023.
What are the most common RPM CPT codes for diabetes patients?
The three most common RPM codes for diabetes patients all involve a physician’s physiologic monitoring of a patient over a one-month period.
The most common RPM code for diabetes patients is current procedural terminology (CPT) code 99457, which covers the first 20 minutes of interactive communication and monitoring between a patient and caregiver in a calendar month. This code accounts for 32.1% of all RPM services for diabetes patients so far this year. With diabetes, patients will often wear a device, such as a continuous glucose monitor (CGM), that measures their glucose levels throughout the day. Healthcare providers can use these devices to monitor a patient’s levels remotely. Any time the provider spends monitoring or analyzing the data from the device, communicating with the patient, or coordinating with the patient’s care team, up to 20 minutes, would qualify for billing this code.
In second place, accounting for 26% of RPM codes for diabetes patients, is CPT code 99454, which covers the supply of the device and the automated data transmission from the patient’s device to the practice’s RPM platform. This code also typically covers the monthly servicing costs of the device as well as the time the practice spends monitoring the data. Code 99454 can only be billed once every 30 days, but in order to qualify for reimbursement, a patient needs to submit at least 16 days of readings over that 30-day period.
Rounding out the top three is CPT code 99458, accounting for 19.2% of all RPM codes for diabetes patients this year. This code is an add-on code to code 99457 and can only apply when a healthcare provider provides more than 20 minutes of remote monitoring, analyzing, and communicating with a patient. The code itself refers to the same services as the first-place code, and it can only be billed once CPT code 99457 has been billed. Depending on the seriousness and complexity of the condition, some remote monitoring and communications may take longer than others, which would explain this code’s placement on the list.
What does RPM for diabetes management look like?
Diabetes is a chronic disorder that affects millions of people worldwide. While there is no cure, type 2 diabetes in particular can be managed with the right lifestyle choices. One effective way to manage diabetes is by keeping blood sugar levels within a normal range. With common medical equipment for patients with diabetes, wireless devices, and telecommunication technology, this can now be done from almost anywhere.
As previously mentioned, an example of this technology would be the continuous glucose monitor (CGM), a device that can measure glucose levels in the interstitial fluid and the fluid between the cells through a small sensor inserted under the skin. The data from this device is then transmitted to a cloud-based platform that the patients and their care providers can access.
For diabetes patients, regular and continuous participation in RPM programs is essential for the program to be effective. By sharing consistent health data with providers, care teams can quickly catch potential issues and change a patient’s treatment plan as needed. This limits the chances of complications and further health problems.
Learn more
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Learn about the latest healthcare trends and see how our solutions could help you navigate the expanding RPM and telehealth markets by starting a free trial.
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