Remote Patient Monitoring for Cardiology Practices: Complete 2025 Implementation Guide

Introduction

Many cardiology practices are already monitoring patients between visits but not capturing available CMS reimbursement for this continuous care work. Structured Remote Patient Monitoring (RPM) programs can help practices:

• Generate recurring revenue through established CMS billing codes
• Support early intervention through continuous monitoring
• Improve chronic disease management approaches
• Meet value-based care requirements

This guide shows cardiology practices how to implement compliant RPM programs that may improve patient outcomes while capturing eligible CMS reimbursement.

What You'll Learn:

• CMS reimbursement codes and 2025 rates
• Revenue potential with different patient volumes
• Clinical protocols for three common cardiology use cases
• Device selection criteria (cellular vs. Bluetooth)
• Step-by-step implementation roadmap
• Common mistakes to avoid

Understanding RPM Reimbursement for Cardiology

CMS Billing Codes for 2025

The Centers for Medicare & Medicaid Services (CMS) recognizes four primary RPM codes for cardiology practices:

*Based on 2025 Medicare Physician Fee Schedule (CMS-1807-F); actual rates may vary by geographic location

Revenue Potential Scenarios

For 100 Active Patients (Meeting All CMS Requirements):

Setup Phase (One-time):

• CPT 99453: $20.16 × 100 patients = $2,016

Recurring Monthly Revenue:

• CPT 99454 (Device/Data): $64.53 × 100 = $6,453
• CPT 99457 (20 min review): $51.55 × 100 = $5,155

Total Monthly: ~$11,608

Annual Recurring Revenue: ~$139,296

Important Note: This represents gross reimbursement potential, not profit. Actual revenue depends on:

• Staff time costs
• Device expenses
• Platform/software costs
• Patient compliance rates
• Billing success rates

Top Clinical Use Cases for Cardiology RPM

Use Case 1: Heart Failure Management

Clinical Rationale:
Research suggests that continuous monitoring may help reduce hospital readmissions through early detection of decompensation. Daily weight and blood pressure tracking can identify fluid retention trends before symptoms become severe.

Monitoring Protocol:

• Weight: Daily measurements (alert if ≥2 lbs gain in 24 hours or ≥5 lbs in one week)
• Blood Pressure: 3-5 times per week (alert if >160/100 or <90/60)
• Heart Rate: Continuous via connected device (alert if >100 at rest or <50)
• Patient Surveys: Weekly symptom assessment (shortness of breath, swelling, fatigue)

Device Recommendations:

• Cellular devices preferred for elderly heart failure patients (simpler setup, fewer compliance barriers)
• Weight scale, blood pressure monitor, pulse oximeter
• Optional: Smart watch for continuous heart rate

Expected Duration: 12+ months (chronic condition management)

Billing Optimization: Can combine with CCM (Chronic Care Management) if patient has 2+ chronic conditions or PCM if patient has 1 complex chronic condition

Use Case 2: Post-Ablation Arrhythmia Management

Clinical Rationale:
Post-ablation patients face ongoing arrhythmia management needs. Long-term monitoring helps detect recurrence early and supports medication optimization.

Important: Frame RPM as long-term arrhythmia management (12+ months), not short-term post-operative monitoring. Short-term monitoring doesn't provide sustainable RPM economics.

Monitoring Protocol:

Weeks 1-6 (Intensive Monitoring):

• Heart rate: Daily readings
• Blood pressure: Daily readings
• Symptom surveys: 3× per week (palpitations, dizziness, chest discomfort)

Months 2-12 (Maintenance Monitoring):

• Heart rate: 3-5× per week
• Blood pressure: 3× per week
• Symptom surveys: Weekly

Device Recommendations:

• Bluetooth devices acceptable for tech-savvy post-ablation patients
• Pulse oximeter with heart rate
• Blood pressure monitor

Expected Duration: 12+ months minimum

Billing Consideration: Document ongoing AFib/arrhythmia management, not just post-procedure recovery

Use Case 3: Diabetic Cardiac Patients

Clinical Rationale:
Many cardiac patients have comorbid diabetes, making comprehensive monitoring valuable. Combined monitoring of glucose and cardiovascular parameters supports integrated disease management.

Monitoring Protocol:

• Blood Glucose: 2× daily (fasting and post-meal)
• Blood Pressure: 3-5× per week
• Weight: 3× per week
• Activity Tracking: Daily step counts

Device Recommendations:

• Cellular devices recommended for convenience
• Glucometer with cellular connectivity
• Blood pressure monitor
• Weight scale
• Optional: Activity tracker

Expected Duration: 12+ months (chronic condition management)

Billing Optimization:

Can stack RPM with Principal Care Management (PCM) for dual-condition monitoring:

• RPM (99454 + 99457): ~$116/patient/month
• PCM (99426 + 99427): ~$87/patient/month
• Combined Potential: ~$203/patient/month

Important: Billing rules for combining programs are complex—consult your billing specialist or RCM partner to ensure compliance.

Device Selection: Cellular vs. Bluetooth

Cellular Devices

How They Work:
Built-in cellular connection transmits data directly to platform (no smartphone needed)

Pros:

• No smartphone required
• Better compliance (simpler for patients)
• Ideal for elderly or non-tech-savvy patients
• Immediate data transmission

Cons:

• Higher upfront cost (~$150-300 per device)
• Monthly connectivity fees

Best For: Heart failure patients, elderly populations, high-risk patients needing reliable monitoring

Available Devices:

• Blood pressure monitors
• Weight scales
• Glucometers
• Pulse oximeters

Bluetooth Devices

How They Work:
Connect to patient's smartphone via Bluetooth; smartphone transmits data to platform

Pros:

• Lower cost (~$50-150 per device)
• No monthly connectivity fees
• Familiar technology for many patients

Cons:

• Requires smartphone
• Requires patient to sync device (compliance risk)
• More technical support needs

Best For: Tech-savvy patients, post-ablation populations, younger cardiac patients

Available Devices:

• Blood pressure monitors
• Weight scales
• Glucometers
• Pulse oximeters
• Thermometers

MEDOMENT Supports Both

MEDOMENT's platform integrates with both cellular and Bluetooth devices, allowing practices to match device type to patient needs. The platform handles:

• Automated data collection from both device types
• Unified dashboard showing all patient data
• Same billing workflow regardless of device type
• Alert management for both connectivity methods

5-Step Implementation Guide

Step 1: Define Your Target Patient Population

Start with ONE condition:

• Heart failure (highest readmission risk)
• Post-ablation AFib management
• Diabetic cardiac patients

Identify 25-50 patients who meet criteria:

• 1complex chronic condition for PCM (2+ Chronic conditions enables CCM billing)
• Medicare/Medicare Advantage coverage
• Willing to use monitoring devices
• Clinically appropriate for remote monitoring

Tip: Start with patients you're already monitoring informally—RPM structures what you're already doing and enables reimbursement.

Step 2: Select Technology Platform & Devices

Platform Requirements:

• EHR integration capability
• Automated time tracking (for billing compliance)
• Alert management system
• Cellular AND Bluetooth device support
• Patient-facing mobile app
• Billing documentation automation

MEDOMENT offers:

• Complete RPM platform
• Multiple engagement models (Platform Only, Hybrid, Full Service)
• Revenue-share pricing (no upfront platform fees)
• Clinical staff support available
• Built-in compliance tools

Device Selection:

• Cellular devices for elderly/high-risk populations
• Bluetooth devices for tech-comfortable patients
• Mix based on your patient demographics

Step 3: Establish Clinical Protocols

For Each Condition, Define:

1. Monitoring Frequency: How often should patients take readings?
2. Alert Thresholds: What values trigger clinical review?
3. Response Protocols: Who responds to alerts? Within what timeframe?
4. Escalation Pathways: When does patient need phone call vs. office visit vs. ER?

Example Heart Failure Protocol:

Daily Weight → Alert if ≥2 lbs increase in 24 hrs

→ Nurse calls patient within 4 hours

→ Reviews diet, medication compliance

→ Physician contacted if no clear explanation

→ Medication adjustment or office visit scheduled

Document Everything: CMS requires documentation of:

• Monitoring plan
• Alert responses
• Time spent on patient management
• Clinical decision-making rationale

Step 4: Enroll & Train Patients

Patient Enrollment Process:

1. Clinical Assessment: Is patient appropriate for RPM?
2. Verbal Consent: Explain program, obtain verbal agreement
3. Device Setup (CPT 99453):

• In-office device configuration
• Patient education on device use
• App setup/training
• Document 20+ minutes of setup time

1. Set Expectations:

• "Take readings daily" (or per protocol)
• "We'll call if we see concerning patterns"
• "This helps us help you between office visits"

Training Tips:

• Demonstrate device multiple times
• Have patient demonstrate back to you
• Provide written instructions
• Include caregiver in training when possible
• For cellular devices: Emphasize "just use it—it sends automatically"
• For Bluetooth: Teach smartphone sync process

Step 5: Ongoing Monitoring & Billing

Monthly Workflow:

Week 1-4: Data Collection

• Platform automatically collects device data
• Staff monitors alerts/dashboard
• Respond to concerning trends

Mid-Month: Clinical Review (CPT 99457)

• Review each patient's data (minimum 20 minutes/patient/month)
• Document clinical decision-making
• Platform tracks time automatically

End of Month: Billing Submission

• Platform exports billing-ready documentation
• Submit claims:
• 99454 (if patient met 16-day transmission requirement)
• 99457 (if 20+ minutes clinical time documented)
• 99458 (if additional 20-minute increments documented)

MEDOMENT Automation:

• Tracks 16-day transmission compliance automatically
• Time-tracking for clinical staff
• Generates billing-ready documentation
• Flags patients who haven't met requirements

Common Mistakes to Avoid

Mistake 1: Treating RPM as Short-Term Post-Op Monitoring

The Problem: Enrolling patients only for 2-4 weeks post-procedure doesn't provide sustainable economics

The Solution: Frame RPM as long-term chronic disease management (12+ months). Post-ablation becomes "ongoing arrhythmia management," not "post-procedure monitoring."

Mistake 2: Not Tracking Clinical Time

The Problem: Can't bill 99457 without documented clinical time (minimum 20 minutes/patient/month)

The Solution: Use platform with automated time tracking. Start timer when reviewing patient data, responding to alerts, or making clinical decisions.

Mistake 3: Selecting Wrong Device Type for Patient Population

The Problem: Giving Bluetooth devices to elderly heart failure patients creates compliance issues

The Solution: Match device to patient tech comfort:

• Cellular → Elderly, high-risk, non-tech-savvy
• Bluetooth → Younger, tech-comfortable patients

Mistake 4: No Clear Alert Response Protocols

The Problem: Alerts come in, but staff doesn't know who responds or how quickly

The Solution: Document clear protocols:

• Who monitors dashboard?
• What triggers immediate call vs. next-day follow-up?
• When does physician get involved?
• How is everything documented?

Mistake 5: Ignoring the 16-Day Transmission Requirement

The Problem: Can't bill 99454 unless patient transmitted data on 16+ days in the month

The Solution:

• Choose devices that auto-transmit (cellular)
• Monitor compliance mid-month
• Call patients who aren't transmitting
• Platform should flag non-compliant patients automatically

FAQ: Cardiology RPM Implementation

Q1: Can we bill RPM and CCM together for the same patient?

A: RPM and CCM can often be billed together if the patient qualifies for both programs (2+ chronic conditions) and you're meeting the distinct requirements of each program. However, billing rules are complex and evolving—consult your billing specialist or RCM partner to ensure compliance with current CMS guidance.

Q2: Do patients need to have Medicare for RPM billing?

A: While Medicare established RPM codes, many Medicare Advantage plans and commercial insurers also reimburse RPM. Check coverage with each payer. Medicare remains the most straightforward for RPM billing.

Q3: What if a patient doesn't transmit data for 16 days?

A: You cannot bill CPT 99454 for that month. However, you still provided the device and should continue monitoring. Some months patients will meet the requirement, others they won't. This is normal—focus on overall program compliance rates.

Tip: Mid-month compliance check helps catch patients who aren't transmitting, giving you time to re-engage them before month-end.

Q4: How do we handle after-hours alerts?

A: Most practices establish alert thresholds that require next-business-day response for non-emergency situations. True emergencies (severe hypotension, extreme tachycardia) should trigger existing emergency protocols (call 911, go to ER).

MEDOMENT Approach: Platform allows configurable alert urgency levels. Critical alerts can trigger immediate notification; non-urgent alerts queue for next-business-day review.

Q5: What's the patient compliance rate we should expect?

A: Compliance varies significantly by:

• Device type (cellular > Bluetooth)
• Patient population (younger > elderly, paradoxically)
• Condition severity (sicker patients often more compliant)
• Practice engagement approach

Realistic Targets:

• 70-80% with cellular devices
• 60-70% with Bluetooth devices
• Improves with regular patient engagement

Note: You don't need 100% compliance to build successful RPM program—focus on patients who engage consistently.

Q6: Can clinical staff (nurses, MAs) perform the monitoring, or does it require physician time?

A: Clinical staff can perform monitoring and data review under general physician supervision. The physician must be available for consultation and should review complex cases. CPT 99457/99458 can be billed for qualified clinical staff time under physician supervision.

Key: Staff must be clinically trained and following physician-approved protocols.

Summary: Your RPM Implementation Roadmap

Immediate Steps (Month 1):

Week 1-2:

• [ ] Identify target patient population (start with one condition)
• [ ] Select technology platform (evaluate MEDOMENT)
• [ ] Decide on device types (cellular vs. Bluetooth)

Week 3-4:

• [ ] Establish clinical protocols and alert thresholds
• [ ] Train clinical staff on platform and protocols
• [ ] Enroll first 10-25 patients
• [ ] Complete device setup and patient education

Growth Phase (Months 2-3):

• [ ] Monitor first cohort's compliance and outcomes
• [ ] Refine protocols based on early experience
• [ ] Expand to 50-100 patients
• [ ] Track first billing cycle results
• [ ] Adjust device selection if needed

Optimization Phase (Months 4-6):

• [ ] Scale to target patient volume
• [ ] Add additional conditions/use cases
• [ ] Optimize alert response workflows
• [ ] Consider adding CCM or PCM for eligible patients
• [ ] Review financial performance (revenue vs. costs)

Expected Outcomes

Potential Clinical Benefits:

• Earlier detection of concerning trends
• More proactive medication management
• Improved patient engagement in their care
• Support for chronic disease management protocols

Financial Considerations:

• Recurring monthly revenue from CMS reimbursement
• Offset by device costs, platform fees, and staff time
• Profitability depends on your specific cost structure and patient volume
• Most practices reach positive ROI with 75-100+ active patients

Operational Benefits:

• Structured approach to between-visit care
• Documentation of work already being done informally
• Support for value-based care contracts
• Enhanced patient satisfaction through continuous engagement

Get Started with MEDOMENT

MEDOMENT specializes in RPM implementation for specialty practices, including cardiology. Our platform is designed to make RPM practical and profitable:

Three Engagement Models:

1. Platform Only: Use our technology, your staff manages patients
2. Hybrid Solution: Our clinical team augments your staff
3. Full Service: We handle all monitoring and care coordination

All models available on revenue-share basis—no upfront platform fees.

Platform Advantages:

• Automated Time Tracking: Built-in compliance for CPT 99457/99458 billing\
• Cellular + Bluetooth Support: Match device to patient needs
• EHR Integration: Works alongside your existing systems
• Alert Management: Configurable thresholds and response workflows
• Billing Documentation: Automated export of billing-ready documentation
• Patient App: Engages patients with education and feedback

Ready to Implement RPM?

Schedule a Consultation:

Email: contact@medoment.com

Disclaimers

Medical Professional Responsibility:
This guide provides general information about RPM implementation. All clinical protocols must be reviewed and approved by qualified physicians. MEDOMENT provides software and support services only—we are not a healthcare provider and do not make medical decisions.

Billing Compliance:
CMS billing rules are complex and subject to change. This guide reflects our understanding of 2025 requirements, but practices are responsible for ensuring their own billing compliance. Consult qualified billing specialists, RCM companies, or legal counsel for billing guidance.

Financial Projections:
Revenue calculations represent gross reimbursement potential based on CMS fee schedules, not guaranteed outcomes or profit projections. Actual results depend on patient compliance, billing success rates, cost structure, and numerous other factors specific to each practice.

No Medical Advice:
This content is for healthcare professionals implementing RPM programs—it does not constitute medical advice for patients.

References & Resources

CMS Resources:

• 2025 Medicare Physician Fee Schedule (CMS-1807-F)
• CMS RPM Billing Guidelines: cms.gov/medicare/coverage/telehealth

Clinical Guidelines:

• American College of Cardiology: www.acc.org
• American Heart Association: www.heart.org
• Heart Failure Society of America: www.hfsa.org

Further Reading:

• CMS Remote Patient Monitoring FAQ
• ACC/AHA Heart Failure Management Guidelines
• MEDOMENT RPM Implementation Resources

Last Updated: December 24, 2025