FAQ

01

Implantable 

Device 

Monitoring

Read below to find frequently asked questions & answers related to Implantable Device Monitoring

Can a physician bill for an in-person programming evaluation during the same 90-day period covered by a remote evaluation?


Yes. A physician can bill for an in-person programming evaluation, but not an in-person interrogation evaluation.



How often can a physician bill for an in-person device programming evaluation when a patient is being remotely monitored?


There are currently no frequency limitations for in-person device programming evaluations (i.e., 93279-93284). In general, in-person device programming evaluations may be performed as often as is medically necessary.



Can a physician bill for the technical service of a remote or in-person device evaluation if a device manufacturer representative completes the entire service?

No, physicians would only bill for the professional component of the service by appending a -26 modifier to the procedure code. In order to bill Medicare for the technical service of a procedure, physicians must either perform the procedure or appropriately supervise qualified staff who complete the procedure. In general, in-person device evaluations (CPT codes 93279-84, 93288-90) require "direct supervision" and remote device evaluations (CPT codes 93296, 93299) require "general supervision" by a physician. According to CMS claims processing guidelines, however, "supervision requirements for physician billing is not met when the test is administered by supplier personnel regardless of whether the test is administered at the physician's office or at another location". Providers should contact their local Medicare MAC or other expert sources for additional clarification as needed.

02

Wearable Cardiac Monitoring

Read below to find frequently asked questions & answers related to Wearable Cardiac Monitoring

Holter Codes
1-2 Days - Up to 48 Hours
93235 Hook Up
93227 Physician Interpretation
3-7 Days > 48 Hours < 7 Days
93242 Hook Up
93244 Physician Interpretation
Event Codes
Up to 30 Days
93270 Hook Up
93272 Physician Interpretation
MCT Codes
Up to 30 Days
93228 Physician Interpretation

03

CHF & Hypertension Remote Monitoring

Are there patient co-pays for the CCRPM CPT Codes 99453, 99454, 99457, and 99458 (the “CCRPM Codes”)?

Yes. As with all Medicare services, patients are responsible for all applicable co-payments and cost-sharing amounts. Medicare Part B beneficiaries are typically responsible for a 20% co-pay each time a code is billed.

Is CPT Code 99453 reimbursed per device or per patient? For example, if a patient has two devices that require two separate education and setup appointments, is reimbursement available for both sessions?

CPT Code 99453 can only be reported once per patient per episode of care, regardless of how many devices are used to monitor the patient for that episode of care. For purposes of RPM and CCRPM, an “episode of care” begins when the service is initiated and ends when targeted treatment goals are attained. If another device is used at some point for the same patient but relating to a different episode of care, setup and education for that device would be separately reimbursable.

Is CPT Code 99454 reimbursed per device or per patient? For example, if a patient has a condition or conditions that require two separate monitoring devices for the same episode of care, is separate reimbursement available for the supply of each device?

CPT Code 99454 can only be billed once per patient each 30 days, regardless of whether the patient is using one device or multiple devices.

The CPT Manual states that CPT Codes 99453 and 99454 require at least 16 days of monitoring before they can be billed. Does this mean that patients must transmit data every day for 16 days in order for the billing practitioner to bill these codes?

The CPT Manual states: “Do not report 99453 for monitoring of less than 16 days” and “Do not report 99454 for monitoring of less than 16 days.” However, neither the 2019 nor the 2020 Medicare Physician Fee Schedule reference a similar requirement, nor do they indicate that data must be transmitted every day for 16 days. It is quite possible that the “16 days” referenced in the CPT Manual is meant to distinguish short-term diagnostic monitoring that is generally separately billable under another CPT code from the longer-term monitoring contemplated by these RPM codes. CMS has not issued further guidance on this issue, so providers should use their professional judgement when deciding whether to bill CPT codes 99453 and 99454.

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