CCP RPM & Telehealth Delivery 2 — Questions and Answers
Question 1: Under Medicare's RPM benefit, what is the minimum number of days per 30-day period that physiologic data must be transmitted for the monitoring service code to be billed?
- 8 days
- 16 days (Correct answer)
- 30 days
- 20 days
Correct answer: 16 days
Medicare requires that physiologic data be transmitted at least 16 days out of any 30-day period to bill RPM monitoring codes (e.g., CPT 99457).
Question 2: A patient enrolled in an RPM program stops transmitting blood glucose readings for three consecutive weeks. What is the most appropriate care team action?
- Immediately disenroll the patient
- Attempt outreach via phone or portal to assess barriers (Correct answer)
- Bill for monitoring regardless and address at the next visit
- Escalate directly to the emergency department
Correct answer: Attempt outreach via phone or portal to assess barriers
Proactive outreach to identify and address barriers (technology issues, health status changes, low engagement) is the recommended step before considering disenrollment.
Question 3: Which telehealth modality is considered most appropriate for an initial RPM setup and patient education session?
- Asynchronous store-and-forward only
- Synchronous audio-video visit (Correct answer)
- Text message alone
- Automated IVR call
Correct answer: Synchronous audio-video visit
A synchronous audio-video visit allows real-time demonstration of device use, patient Q&A, and assessment of readiness, which is ideal for onboarding.
Question 4: Which of the following is NOT a required element for billing CPT 99453 (RPM device setup and patient education)?
- Device supply to the patient
- Patient education on use of the device
- At least one interactive communication during the month (Correct answer)
- Initial set-up of the monitoring device
Correct answer: At least one interactive communication during the month
CPT 99453 covers device setup and education only; interactive communication is a requirement for the ongoing management codes (99457/99458), not 99453.
Question 5: A 68-year-old Medicare patient with COPD is enrolled in remote pulmonary monitoring. The care team spends 22 minutes in a month reviewing data and communicating with the patient. Which CPT code combination is most appropriate?
- 99457 only
- 99457 + 99458 (Correct answer)
- 99091 only
- 99454 + 99091
Correct answer: 99457 + 99458
99457 covers the first 20 minutes of RPM management, and 99458 is an add-on for each additional 20 minutes; 22 minutes triggers both codes.
Question 6: What is the primary advantage of store-and-forward telehealth over synchronous visits in dermatology-adjacent chronic wound care?
- It allows real-time two-way communication
- It enables specialists to review images on their own schedule without scheduling constraints (Correct answer)
- It requires less patient consent
- It is always reimbursed at a higher rate than synchronous visits
Correct answer: It enables specialists to review images on their own schedule without scheduling constraints
Store-and-forward allows specialists to review high-resolution images asynchronously, reducing appointment delays and specialist scheduling burdens.
Question 7: When establishing informed consent for RPM, which element is MOST critical to document?
- The brand name of the monitoring device
- Patient understanding of data collection, privacy practices, and the right to withdraw (Correct answer)
- The exact reimbursement rate to the practice
- The name of the EHR system used
Correct answer: Patient understanding of data collection, privacy practices, and the right to withdraw
Informed consent for RPM must include explanation of data collection, how data is used and protected, and the patient's right to discontinue participation.
CCP RPM & Telehealth Delivery 2
Under Medicare's RPM benefit, what is the minimum number of days per 30-day period that physiologic data must be transmitted for the monitoring service code to be billed?