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.
More Questions
If you have any question on billing or how to interpret the Reimbursement Report, feel free to reach out at help@caresimple.com