RPM is a per-patient-per-month business. So start with the arithmetic.
Whether this works depends on your panel size, how many patients enroll, and how many hit the 16-day threshold each month. Change any of those below and the estimate changes with them.
Illustrative estimate only. Assumes CPT 99454 requires at least 16 days of readings in a 30-day period and CPT 99457 requires interactive communication. Actual reimbursement depends on payer mix and documentation.
Every code has a condition attached. We keep them attached.
| Code | What it covers | Requirement |
|---|---|---|
| 99453 | Setup and patient education | One-time. Covers device setup and teaching the patient to use it. |
| 99454 | Device supply and transmission | Requires at least 16 days of readings in a 30-day period. No 16 days, no bill. |
| 99457 | First 20 minutes of management | Requires interactive communication with the patient during the month. |
| 99458 | Each additional 20 minutes | Billed per additional 20 minutes of management time, documented. |
Patient consent must be obtained and documented before billing. We capture and store that consent as part of enrollment.
Device logistics and staff time.
Here is who does what, by name of task.
Some months don't bill. We'd rather you hear that from us.
Patients disengage
Some enrolled patients stop taking readings. Below 16 days in the period, 99454 doesn't bill for that month. Our follow-up reduces this — it doesn't erase it.
Devices fail
Hardware breaks or batteries die. We replace them, but a gap in transmission can still cost a billing month.
Months that don't bill
A share of your enrolled panel will not produce a billable month. The calculator's compliance rate is exactly this — lower it to see a conservative number.
If RPM isn't your fit, we'll point you the right way.
Most of your revenue is specialty drugs?
- —You're hematology, oncology, nephrology, pulmonary, or rheumatology
- —Drug acquisition cost is your largest line
- —Panel size matters less than drug spend
Panel's big enough, but no bandwidth?
- —The math works but you can't add staff
- —You don't want RPM landing on your nurses
- —You want the enrollment and documentation run for you