CPT Code 99091 Billing Guidelines & Coding Requirements

CPT Code 99091 Billing Guidelines & Coding Requirements

CPT code 99091 relates to the remote collection and interpretation of physiological data. This RPM CPT code should only be reported once every 30 days to include the time spent by the physician or other qualified healthcare professional on data entry, review and interpretation, care plan modification, and associated documentation.

The Centers for Medicare and Medicaid Services (CMS) formulated the billing standards for RPM Code 99091 to account for the time required to evaluate and interpret patients' physiological data in order to treat a specific health condition. CPT code 99091, like all other RPM codes, has a specific set of Medicare reimbursement requirements that physicians and clinicians should be aware of.

Latest Guidelines for CPT Code 99091

In 2018, Medicare granted coverage and RPM payment (CPT code 99091) for physicians and other eligible healthcare professionals who gather and analyze digitally transmitted and stored physiologic data. The 2024 CMS final rule empowers physicians, clinicians, and other healthcare professionals to use remote patient monitoring services to improve patient care and health outcomes while increasing income and reimbursements.

● For Healthcare

Providers

CMS requires that a physician or a competent healthcare professional analyze the physiologic data provided by CPT code 99091 billing requirements for RPM. Data processing and interpretation occur after the data has been transmitted and gathered using the CPT codes 99453 and 99454.

The guidelines describe a competent healthcare professional as someone who, through education, training, licensure/regulation, and facility privilege, provides a professional service within his or her field of practice and reports on it independently

● For Medicare Patients

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All Medicare patients are eligible for and can use RPM services. CMS considers RPM a telehealth service, while Medicare does not. This is why Medicare covers remote patient monitoring equipment in patients' homes, regardless of where they live.

Coding Requirements for CPT Code 99091

The billing rules for CPT Code 99091 are comparable to those of the other four remote patient monitoring CPT codes.

● An RPM device must meet the FDA's definition of a medical device.

● Before ordering a device, the patient must first agree to the service.

● Patients who have never had RPM before must undergo a new patient examination.

● Patients who were enrolled in RPM during the Public Health Emergency (PHE) can continue to receive the program.

● To bill for CPT codes 99453 and 99454, the patient must use the RPM device for at least 16 days per month.

● All data acquisition must be HIPAA-compliant.

What Services Does CPT Code 99091 Cover?

The CMS final rule specifies that "the collection and analysis of physiologic data recorded digitally and/or communicated by the patient and/or caregiver to the physician or other qualified healthcare professional, requiring at least 30 minutes of time every 30 days.

Code 99091 requires healthcare workers to spend at least 30 minutes every calendar month collecting, interpreting, and processing RPM data transmitted by patients. It also includes at least one patient-to-healthcare professional communication session, which can take place over the phone or via email and provides medical treatment or monitoring recommendations.

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