Unlike traditional face-to-face visits, RPM generates revenue on a recurring, monthly basis. To avoid catastrophic Medicare clawbacks, your billing cycle must strictly track four distinct phases of the program.
Billing for the initial phase where the FDA-cleared device is provided and the patient is educated on its use. We verify documented consent before dropping the claim.
Managing the monthly recurring claims for the supply of the device and its daily transmission of data (must hit the CMS 16-day minimum threshold).
Billing for the first 20 minutes of clinical staff time spent interacting with the patient or modifying care plans based on device readings.
Accurately logging and submitting add-on codes for every additional 20 minutes of clinical time spent beyond the initial requirement.
Our certified coders ensure these codes are billed precisely according to the Medicare Physician Fee Schedule (MPFS) guidelines.
| CPT Code | Description | Frequency |
|---|---|---|
| 99453 | Initial set-up and patient education on use of equipment. | Once per episode |
| 99454 | Device supply with daily recordings or programmed alerts. (Requires 16 days of data transmission). | Monthly |
| 99457 | First 20 minutes of clinical staff time directed by a physician/QHP in a calendar month. | Monthly |
| 99458 | Each additional 20 minutes of clinical staff time (Add-on code to 99457). | Add-on |
Don't risk CMS audits due to poor time-tracking or incorrect modifiers. Let Probiz manage your RPM billing so you can scale your remote care program confidently.
Talk to an RPM ExpertWe combine certified expertise with proprietary technology to deliver unmatched revenue cycle performance.
Our advanced rules-based scrubbing engine runs every claim against millions of payer-specific rules before submission, practically eliminating front-end rejections and accelerating your cash flow.
We don't use generalists. Your account is managed by specialty-specific certified coders who understand the nuances of your exact clinical discipline, ensuring maximum compliant reimbursement.
Stop waiting for end-of-month reports. Our proprietary BI dashboards give you real-time visibility into collection rates, A/R aging, and denial trends.
We work seamlessly within your existing software via secure, HIPAA-compliant VPNs. Zero data migration required, and zero disruption to your clinical workflow.
Switching billing partners shouldn't disrupt your cash flow. Our meticulously engineered onboarding process ensures a smooth, parallel transition.
We establish secure remote access to your EHR/PMS and map your existing workflows without interrupting your current team.
We audit your past claims to identify immediate revenue leakage, coding errors, and systemic denial trends.
Our rules-based scrubbing engine is programmed with your specific payer matrix and local coverage determinations to prevent future denials.
We take over day-to-day operations, instantly applying our optimized workflows to accelerate your cash flow and reduce days in A/R.
Common questions about our process, integration, and security.
