Remote Patient Monitoring
POLICY
Remote Patient Monitoring is the use of digital devices to measure and transmit personal health information from a beneficiary in one location to a provider in a different location. Remote patient monitoring enables providers to collect and analyze information such as vital signs (blood pressure, heart rate, weight, blood oxygen levels) in order to make treatment recommendations. There are two types of remote patient monitoring addressed within this policy:
- Self-Measured and Reported Monitoring: When a beneficiary uses a digital device to measure and record their own vital signs, then transmits the data to a provider for evaluation.
- Remote Physiologic Monitoring: When a beneficiary’s physiologic data is wirelessly synced from a beneficiary’s digital device where it can be evaluated immediately or at a later time by a provider.
Remote patient monitoring, including:
- self-measured blood pressure monitoring; and
- remote physiologic monitoring.
List of eligible Remote Patient Monitoring Services provided on page 15 of Attachment A of the Telehealth, Virtual Communications and Remote Patient Monitoring manual. FQHCs, FQHC Lookalikes and RHCs are allowed to bill for RPM codes.
Guidance: Self-Measured Blood Pressure Monitoring (SMBPM)
SMBPM is a beneficiary’s regular use of a personal blood pressure monitoring device to assess and record blood pressure across different points in time outside of a clinical setting, typically at home. This service is available for new or established patients. SMBPM require a device that is wirelessly synced where the provider can evaluate the data in real or near-real time. All remote patient monitoring must be conducted in a HIPAA compliant manner, particularly with respect to protecting transmission of patient health data.
Guidance: Remote Physiologic Monitoring (RPM)
RPM is the collection and interpretation of an established beneficiary’s physiologic data digitally transmitted to the eligible provider. Codes 99453 and 99454 are used for device set-up, training and supply – the following guidance applies to both of these codes:
- 99453 and 99454 can be used for blood pressure RPM if the device used to measure blood pressure meets RPM requirements. If the beneficiary self-reports blood pressure readings, the provider should instead bill SMBPM codes 99473/99474.
- 99453 and 99454 cannot be reported if monitoring is less than 16 days in duration.
- Providers should not report codes 99453 or 99454 if the services are included in any other codes covered by NC Medicaid for the duration of time of the RPM (for example, continuous glucose monitoring that is covered under code 95250).
RPM treatment management services are the use of the RPM results by the eligible provider to manage an established patient’s treatment plan. Codes 99457 and 99458 are used to report RPM treatment management services – the following guidance applies to both of these codes.
- Codes 99457 and 99458 require a live, interactive communication between the beneficiary or caregiver.
- Providers may not bill code 99457 or 99458 for interactions of less than 20 minutes.
For all RPM and RPM treatment management service codes in table C.3: If the services described by codes 99453, 99454, 99457 or 99458 are provided on the same day a beneficiary presents for an evaluation and management service to the same provider (whether by telehealth or in-person), these services should be considered part of the E/M service and not billed under the RPM code.
North Carolina Innovations – Supported Living
The Supported Living provider shall be responsible for providing an individualized level of supports determined during the assessment process, including risk assessment, and identified and approved in the Individual Support Plan (ISP) and have 24 hour per day availability, including back-up and relief staff and in the case of emergency or crisis. Some beneficiaries receiving Supported Living services may be able to have unsupervised periods of time based on the assessment process. In these situations, a specific plan for addressing health and safety needs must be included in the ISP and the Supported Living provider shall have staffing available in the case of emergency or crisis. Requirements for the beneficiary’s safety in the absence of a staff person must be addressed and may include use of tele care options. When assessed to be appropriate Assistive Technology elements may be utilized in lieu of direct care staff.
What is telehealth and how does it work?
Telehealth is defined as including remote patient monitoring:
- Remote Patient Monitoring: Remote patient monitoring includes the use of videos submitted by an established patient and/or store and forward, also known as asynchronous telehealth. It is used for collecting diagnostic data, monitoring patients and specialist consultation. It is the use of digital devices to measure and transmit personal health information (like blood pressure) from a beneficiary in one location to a provider in a different location.
CONDITIONS
Phase II Outpatient Cardiac Rehabilitation Programs
Telemetry monitoring is available for at risk patients. See manual for details.
PROVIDER LIMITATIONS
Providers that may bill NC Medicaid for remote patient monitoring include physicians, nurse practitioners; psychiatric nurse practitioner; certified nurse midwives; and physician’s assistants.
FQHCs, FQHC Lookalikes and RHCs are allowed to bill for RPM codes.
Electrocardiography, Echocardiography, and Intravascular Ultrasound
Holter monitoring is not covered for less than a 24-hour monitored period.
Home-based telemetry systems are not covered by N.C. Medicaid.
Federally Qualified Health Centers & Rural Health Clinics
FQHCs and RHCs would be reimbursed on a fee-for-service basis for delivering non-core visit services via telehealth, virtual patient communications, or remote patient monitoring.
OTHER RESTRICTIONS
Remote patient monitoring requires use of a device that is defined by the FDA as a medical device and is in real-time and transmittable. Some forms of remote patient monitoring, such as remote physiologic monitoring (detailed below), require a device that is wirelessly synced where the provider can evaluate the data in real or near-real time. All remote patient monitoring must be conducted in a HIPAA compliant manner, particularly with respect to protecting transmission of patient health data.
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