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Calculating Your Reimbursements

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What CPT Codes Will You Use?

For the purpose of this analysis, we will be focused on the codes related to remote patient monitoring.

 

First, assess your new prenatal schedule. For those who normally bill a global fee to insurers (CPT code 59400), make sure that the new schedule meets the minimum threshold of visits (minimums can vary by state or plan but often the average is 5 visits). Once you confirm this, you can rest assured that you will still be able to capture the same reimbursement for the physician management of the pregnancy.

 

Then, use the following CPT codes as you work in our remote patient monitoring program to set up patients and monitor them remotely.

RPM CPT Codes 01

 Note: Be sure to check with your payers directly to understand if they will reimburse and the exact reimbursement rates.

What Does This Look Like in a “Typical” Private Practice and an Integrated Health System?

Below we share two examples. One for a mid-size private practice with 1,000 annual births and one for a large integrated health system with 15,000 annual births. Using the CPT codes above, we calculate the potential additional reimbursement for adopting telehealth through our program.

 

 

What Will Your Reimbursement Look Like While Using Our Program?

This calculator will estimate the amount of reimbursement expected for the number of pregnant patients during the typical 9 month period for maternity care. Be sure to check with your payers directly to understand if they will reimburse and the exact reimbursement rates.

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