Reimbursement Tips: Remote Physiologic Monitoring (RPM), including self-measured blood pressure (SMBP), involves a patient’s use of devices to assess and record physiologic data outside of the clinical setting, usually in the home. RPM may require additional treatment management services which may be furnished by a qualified provider. Medicare currently does not reimburse RPM services separately from the FQHC PPS payment.
Program Requirements
Remote Physiologic Monitoring (RPM) refers to the use of device(s) for remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate). The medical devices used must be defined by the FDA, and the service must be ordered by a physician or qualified health professional (QHP).
Self-measured blood pressure (SMBP) refers to blood pressure measurement that takes place
outside the clinical setting, often at home. SMBP can assist with both diagnosis and management of hypertension and increases patient participation in their own care. Devices used for SMBP must be validated for clinical accuracy. With respect to coding, SMBP is a type of RPM.
Remote Physiologic Monitoring Treatment Management Services (RPM TMS) are provided
when clinical staff/physician/other qualified health care professional use the result of RPM to manage a patient under a specified treatment plan. RPM TMS involves interactive communication which includes real-time synchronous, two-way audio interaction that is capable of being enhanced with video of other kinds of data transmission.
Related Resources
Visit NACHC’s Value Transformation Framework resources page for more reimbursement tips.
