Checklist: Remote physiological monitoring (RPM)
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for remote physiological monitoring. Health care providers retain responsibility to submit complete and accurate documentation.
| Check | Documentation description |
|---|---|
| Documentation is for the correct beneficiary. | |
| Documentation is for the correct date(s) of service. | |
| Documentation is complete, legible, signed and dated by the physician or clinician. | |
| Documentation supports patient consent for remote monitoring (verbal or audio) |
|
| Documentation supports the device is FDA and HIPPA compliant for remote monitoring | |
| Documentation supports patient education (training) and setup (CPT 99453) | |
| Documentation supports remote patient monitoring device supply (CPT 99454) • Device supply for 30 days • 16 days of physiological data transmission • Data must be automatically transmitted, not manually uploaded • Only one provider per 30‑day period |
|
| Documentation supports the initial 20 minutes of patient monitoring (CPT 99457) • ≥ 20 minutes of time per month • Interactive communication (real‑time audio or video) |
|
| Documentation supports (if needed) additional 20-minute increments for patient monitoring (CPT 99458) • Additional 20 minutes • Must be billed with 99457 • Must include interactive communication |
|
| Any additional documentation to support medical necessity or any applicable policy guidelines for the services billed | |
| Documentation includes an advanced beneficiary notice (ABN) of non-coverage was provided (if applicable and required). | |
| Documentation to support any applicable modifiers billed with the E/M service |
Disclaimer
This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or the CMS documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.