Remote Care Billing Instructions

At the end of every month, CareSimple automatically generates a Reimbursement Report that displays all billable metrics in one spreadsheet. The purpose of this report is to make RPM, CCM and other remote care claims simple.

Reimbursement Report

If you provide the service, it is ultimately up to your organization to determine and confirm billing, and here below is some guidance on how to interpret the Reimbursement Report:

Program	Column	Code	Claim if	Can be claimed
RPM	Start Date	CPT 99453 (Setup)	Date is within the month	Once per episode of care
RPM	Transmission Days	CPT 99454 (Equipment)	There are 16 or more transmission days	Once per 30-day period (usually done month)
RPM	99474	CPT 99474	Separate self-measurements of two readings one minute apart, twice daily over a 30-day period	With a minimum of 12 active days required each billing period.
RPM	99091 Time	CPT 99091 (Physician or QHP RPM Time)	30 minutes or more	Multiple; per 30 minutes
RPM	99457/8 Time*	CPT 99457 and 99458 (Clinical Staff RPM Time)	20 minutes or more (99457)	Multiple; per additional increments of 20 minutes (99458)
CCM	99490 Time	CPT 99490 (Clinical Staff CCM Time)	20 minutes or more	Once per 30-day period (usually done month)
Other	Other Time**	TBD	TBD	TBD

*Time spent on a day when the patient has EM services shall be excluded.

**If your organization provides another type of remote care, you may use the "Other Time" tracking feature in CareSimple and set

General Supervision

The codes require general supervision by a physician (MD) or nurse practitioner (NP) - and can be performed by clinical staff. Per CMS, clinical staff is "a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service but does not individually report that professional service."

Out-of-Pocket Costs

Patients are responsible for applicable copays. The copays can be waived during the COVID-19 public health emergency (PHE). Patients might be able to avoid the associated costs with a Medicare Advantage plan.

Documentation Requirements

The codes are for Part B Services and billed on a 1500 form with the National Provider Identifier (NPI) of the supervising MD or NP.