RPM

Does anyone know how to incorporate the use of RPM devices for wound care patients in their homes. Is there special documentation that needs to go along with this?

Jan 12, 2025 by Lauraine Kanders, APRN

1 replies

Kim Simonson
RN-BC, ACHRN, CWS, FACCWS

Hi Lauraine

Incorporating Remote Patient Monitoring (RPM) devices for wound care patients at home can help enhance care outcomes and patient engagement, but it does come with specific requirements and best practices. Specifically speaking, while other tools can be used to help monitor wound care patients remotely, they might not be CMS billable (e.g., this website appears to show billable RPM services applied to patients with chronic wounds). Another set of billable code applicable to wound care refers to "Virtual Check ins" and "E-visits" (see topic "Reimbursement for Telemedicine Services in Wound Care" and this Novitas article)

According to Telehealth.hhs.gov, RPM includes both remote physiological monitoring and remote therapeutic monitoring. The following remote patient monitoring services are billable:

Remote physiologic monitoring involves the use of non-face-to-face technology to monitor and analyze a patient's physiological metrics. Examples of physiological metrics include oxygen saturation, blood pressure, blood sugar or blood oxygen levels, weight loss or gain.
Remote therapeutic monitoring (RTM) captures non-physiologic data related to a therapeutic treatment. This includes data on a patient’s musculoskeletal or respiratory system. RTM can also monitor treatment adherence (e.g., medication compliance) and treatment response (e.g., pain management). Information is transmitted using a connected medical device.

Medicare reimburses for both remote physiological monitoring and RTM.

Requirements for RPM include:

Remote physiologic monitoring, but not RTM, requires an established patient relationship.
Remote physiologic monitoring service must monitor an acute or chronic condition.
Remote physiologic monitoring must be collected for at least 16 days out of 30 days.

16-day data collection in a 30-day period does not apply to treatment management codes 99457, 99458, 98980, and 98981.

Only one practitioner can bill for RPM per patient in a 30-day period.
Remote physiologic monitoring and RTM cannot be billed together.
Monitoring must be medically reasonable and necessary.
Remote physiologic monitoring and RTM, but not both, may be billed concurrently with the following care management services for the same patient as long as time and effort are not counted twice: chronic care management (CCM), transitional care management (TCM), behavioral health integration (BHI), principal care management (PCM), chronic pain management (CPM).
For global periods of surgery, remote physiologic monitoring and RTM may be billed by practitioners that are not receiving the global service payment.
Patient consent is required at the time RPM is furnished.
Physiologic data must be electronically collected and automatically uploaded to a secure location where the data can be available for analysis and interpretation by the billing practitioner.
The device used to collect and transmit the data must meet the definition of a medical device as defined by the FDA.
The services may be provided by health care personnel under the general supervision of the billing practitioner.

Additional reading:

Telehealth.hhs.gov. Billing for remote patient monitoring: https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-and-remote-patient-monitoring/billing-remote-patient
American College of Physicians. Remote Patient Monitoring Billing, Coding and Regulations Information. https://www.acponline.org/practice-resources/business-resources/telehealth-guidance-and-resources/remote-patient-monitoring-billing-coding-and-regulations-information

Hope this helps!

Jan 15, 2025

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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