RPM Reimbursement: What Every Provider Should Know

Remote Patient Monitoring (RPM) is one of the most effective ways to extend care, improve outcomes, and strengthen patient engagement. But for practices, the real challenge is often how to get reimbursed. Here’s what you need to know in 2024 — reorganized into a clear roadmap.

1. Start With the Rules That Matter Most

Before diving into billing codes, providers need to understand the ground rules CMS has set:

  • 16-day requirement: To bill CPT 99453 and 99454, at least 16 days of patient data must be captured within a 30-day period.

  • Established patient relationship: RPM services can only be provided to existing patients (unlike RTM).

  • One provider per patient: Even if multiple devices are used, only a single practitioner can bill RPM for each 30-day cycle.

  • Automatic device transmission: Self-reported data does not count — only FDA-cleared devices that sync automatically are eligible.

2. Know What Devices Qualify

Not all gadgets count as medical devices. For reimbursement, the technology must meet FDA standards and transmit physiological data without manual entry. Common examples include:

  • Blood pressure monitors

  • Glucose meters

  • Pulse oximeters

  • Digital weight scales

3. Understand Patient Responsibility

Medicare beneficiaries generally owe 20% coinsurance for RPM services under Part B. This cost may be covered if patients have supplemental insurance or Medicaid, but it usually cannot be waived outright. Setting expectations early helps avoid confusion.

4. Recognize Who Pays

RPM is reimbursable across multiple payer types:

  • Medicare – the most consistent and widely used pathway through CPT codes

  • Medicaid – as of 2023, 37 states cover some form of RPM

  • Commercial insurers & ACOs – many now recognize RPM, though policies differ by region and plan

5. Break Down the CPT Codes and Payment Rates

Medicare has established four key CPT codes for RPM reimbursement. National, non-facility averages for 2024 are:

  • 99453 – Initial setup and patient education — $19 (one-time)

  • 99454 – Device supply, data transmission, and reporting — $46/month

  • 99457 – First 20 minutes of clinician or staff review/management — $48/month

  • 99458 – Each additional 20 minutes — $38/month

Actual reimbursement varies by payer and geography.

6. Pair RPM With Other Services

RPM is particularly powerful when combined with Chronic Care Management (CCM). Both can be billed in the same month if time is tracked separately. Example:

  • 20 minutes of RPM (99457)

  • 20 minutes of CCM (99490)
    = 40 minutes total, supporting billing for both services.

7. Don’t Forget FQHCs and RHCs

A recent update means Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can now bill for both RPM and Remote Therapeutic Monitoring (RTM) as of January 1, 2024. This expands remote care access to previously underserved populations.

The Takeaway

Reimbursement doesn’t have to be a stumbling block. With the right understanding of coverage, coding, and compliance, practices can confidently run RPM programs that improve care and create sustainable revenue.

At NowRPM, we simplify the process by pairing user-friendly devices with billing guidance and operational support. That way, you can focus less on navigating codes — and more on delivering proactive, connected care.

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