As is often the case with complex questions, the answer is "it depends."

The reason is that CMS has several different programs for remote monitoring, and each one has different reimbursements. At least recently, the most popular plan is one was created when CMS created five new CPT codes in July of 2022. They are listed here along with their average billable amount.

There isn't any requirement that you utilize the same program from one patient to another. For patients whom you are monitoring a single condition, in many instances this program might yield the greatest total revenue. It should be noted, that with this plan, our interpretation is that the cost of the device(s) is expected to be born by the provider organization and is offset by CPT Code 99091. We believe that would be prohibitive in scenarios where the devices are inordinarily expensive or the patient conditions necessitated several medical devices. It should also be noted that for patients covered by private insurance, our research has shown that devices can be prescribed. Accordingly, reimbursements are likely to be determined by your organization's negotiated contract.

The greatest financial incentive

Regardless of the reimbursement program you choose, the savings you achieve through a reduction of repetitive Emergency Department visits and the reduced number of required readmssions for in-patient treatment will dwarf the potential reimbursement.

More complex remote patient monitoring programs are those for chronic disease managmement. There are three of them, differentiated by:

• The time spent on care management
• Who provides the service
• Complexity

1. Non-complex clinical staff
2. Complex clinical staff
3. Physician driven

As with the other remote patient monitoring program described above, only one series of CCM codes can be billed per patient per month. We will cover them here, one at a time begining with Non-Complex Chronic Care Management. To qualify for this category, the patient must be diagnosed with two or more chronic conditions. Here is the detail:

CPT Code 99439 can be billed can be billed with CPT 99490 a maximum of two times per month for a total of 60 minutes or $156 which is the most that can be billed under this program

The second, and we believe the most attractive CCM program is Complex CCM Management for Clinical Staff. To qualify, patients must have three or more chronic conditions. In this category, 60 or 90+ minutes are spent per calendar month on non-face-to-face CCM services - all of which can be delivered by clinical staff with physician supervision. In addition to the attraction of being able to stack CPT 99487 minutes, the staff flexibility also is attrative. Also, with this category as with the non-complex program, medical devices are able to be prescribed rather than incorporated into the per-patient cost.

The third and final program is for Physician-Driven CCM. This is just what the title implies, in that the entireity of the care is delivered by a physician. Here are the details:

In summary, as stated above we believe the staffing flexibility combined with the ability to stack additional time as required creates an attractive opportunity for patients and providers. Also, the ability to prescribe devices