Abstract 4367905: Medicare utilization and reimbursement patterns of remote monitoring for hypertension across primary care, nephrology, and cardiology

Abstract

Background: Remote physiologic monitoring (RPM) codes are increasingly being used to manage hypertension. Internists commonly perform hypertension monitoring and RPM-related billing. However, it remains unclear to what extent various specialties like cardiology and nephrology utilize remote monitoring for hypertension and are reimbursed for these RPM services. Hypothesis: We hypothesized that cardiologists perform and bill more RPM services (for the three most common codes for remote monitoring of hypertension) but receive the same Medicare reimbursement per procedure as PCPs (Family Medicine and Internal Medicine) and nephrologists. Methods: We analyzed the 2023 Medicare Physician and Other Practitioners Public Use File, identifying utilization of 3 standard remote physiological monitoring CPT codes 99453 (Digitally Stored Data Services/Remote Physiologic Monitoring), 99454 (Digitally Stored Data Services/Remote Physiologic Monitoring), and 99457 (Remote Physiologic Monitoring Treatment Management Services). Providers looked at were Cardiologists, PCPs (internal and family medicine), and Nephrologists. We calculated the total, per-patient, and per-provider Medicare payments and services rendered. Inferential statistics included ANOVA comparing payments and service volumes between groups. Results: A total of 976 Cardiologists, 3,221 PCPs, and 401 Nephrologists submitted RPM-related claims. Cardiologists had the highest service volume per provider across all 3 CPT codes compared to internists or nephrologists. Cardiologists had the highest average per-patient reimbursement ($196.15) compared to Nephrologists ($187.64) and PCPs ($171.27). Across all three CPT codes, significant differences were observed in both mean payment per service ( p < 0.001) and service volume ( p < 0.001). The most crucial discrepancy was observed for CPT 99454, where cardiologists averaged $239.07 per patient vs. $200.97 (PCPs) and $209.11 (Nephrologists), with all pairwise comparisons reaching statistical significance ( p < 0.01). Nephrologists demonstrated intermediate utilization and reimbursement patterns for all RPM codes, substantially higher than PCPs but consistently lower than Cardiologists. Conclusion: Cardiologists are the predominant service providers for remote monitoring services and receive substantially higher Medicare reimbursement for their services.