Endobits Knowledge Base

If you have questions about Endobits, chronic care management, remote monitoring patients with diabetes, or need any assistance using or understanding the platform, you’ve come to the right place.

 

This FAQ answers the most common questions we receive from our community, and if you don’t see your inquiry here, you can always reach Endobits support via email.

What is Endobits?


Endobits is a remote patient monitoring system that allows you to view data from your patients’ personal medical devices such as a continuous glucose monitor (CGM) or a blood pressure monitor (BPM) on one platform. If your patients use CGMs or BPMs to manage their health, Endobits will automatically track thier data and auto generate RPM reports with all the information you need to bill for RPM and CCM. Contact the Endobits team to set up a provider account.




How do I get my patients set up with Endobits?


Send your patients an invitation to download the Endobits companion app, available on iOS and Android, and create an account. Once they accept your invitation, your accounts will be connected. Alternatively, if they use the Diabits app to assist their blood glucose monitoring, they can connect their Diabits account to your Endobits account.




How does Endobits work?


The Endobits companion app and Diabits work with devices such as CGMs to frequently record the patient’s blood glucose and insulin data. Data is uploaded automatically to your Endobits dashboard as soon as it is recorded and monitored for changes in real time. Processing patient data through the built-in algorithm, Endobits identifies high-risk and high-priority patients for you, enabling you to provide proactive care. Patients will be categorized based on “high priority” issues such as:

  • Spending a significant amount of time outside their usual blood sugar range.

  • Have recurring patterns of severe high or low blood sugar

  • Experiencing severe or prolonged highs or lows

  • Overcorrections

The Endobits companion app and Diabits are helpful interactive apps for patients, allowing them to log additional data such as additional insulin data, meals, exercise, and clinical test results.




We already use telemedicine. How is Endobits different?


While telemedicine is great, Endobits goes much further by delivering virtual care. Endobits does not require face-to-face or telemedicine visits. Endobits software will prioritize your patient list automatically so the patients who are in most need of care will appear first on your dashboard, enabling you to provide care more efficiently. Endobits will monitor your patients’ health, diet, and insulin regimen to provide you with useful and up to date data. In person and virtual / telemedicine appointments can be scheduled and streamlined accordingly, freeing you to provide care to more people without the need to have them on the phone or in the office or on zoom or etc.




What devices are compatible with Endobits?


You can easily access your Endobits provider account on any internet-connected device. The Endobits companion app that your patients use is available for iOS and Android. Patients can also download Diabits, an intelligent diabetes management app by Bio Conscious. Endobits is currently designed to be compatible with any Dexcom device including Dexcom Share, Freestyle Libre, MiaoMiao 2, and Nightscout. We are always working on integrating more devices. If your device is not supported, let us know.




Why should I choose Endobits when I already have Dexcom CLARITY or similar?


Endobits provides the insights you need, on an interface that’s easy to use and understand. The Endobits platfrom will automatically prioritize patients who have experienced high-risk events, such as overnight lows or overcorrections, and monitors for improvements or deteriorations in overall management. In sec’s, you’ll know who’s most at risk and why. You can also receive decision support as Endobits automatically recommends areas of focus to help with treatment success (“Beta” release). And we work with most sensors and devices that are currently used by your patients. Proprietary tools such as the Glucose-Insulin report also surpasses typical Ambulatory Glucose Profile charts. By displaying a patient’s overall blood glucose control combined with insulin dosages, it paints a much more complete picture of their health and highlights opportunities for improvement.




How much does Endobits cost?


You can try Endobits for free for 30 days. Beyond this commitment-free trial, rates start from $500/month. For larger clinics and etnreprise level clients the rates may change based on the number of users, including both providers and patients. Contact us at support@endobits.com for more details.




What are the primary CPT codes?


There are five primary Medicare RPM codes are CPT codes 99091, 99453, 99454, 99457, and 99458.




Which payment methods do you accept?


We only accept credit card payments at this time. When you create your account for your free trial period, we will collect your credit card information for security purposes, but you won’t be billed for the duration of your trial period.




Is there a limit to how many patients or providers I can have on one account?


Endobits can support as many providers and patients as you need. There’s no limit, though the number of patients and providers on your account may affect your subscription rate. Email us at support@endobits.com for more information.




What is remote patient monitoring (RPM)?


Often abbreviated as RPM, remote patient monitoring (also known as remote patient management) involves the collection and analysis of patient physiologic data and using it to develop, manage, or alter treatment plans related to a chronic health illness or condition.




Who qualifies for RPM?


Practitioners can furnish RPM services for patients with acute conditions and chronic conditions.




Can RPM only be used for established patients?


The 2021 Proposed Rule, CMS limited RPM services to “established patients.” CMS waived this restriction temporarily for the duration of the Public Health Emergency (PHE).




Are RPM codes considered E/M services?


RPM codes are considered the same as Evaluation and Management (E/M) services.




Who can order and bill for RPM services?


CMS stated they can be ordered and billed only by physicians or nonphysician practitioners who are eligible to bill Medicare for E/M services.




How can I use RPM for new patients ?


CMS waived this restriction temporarily for the duration of the Public Health Emergency (PHE). CMS requires that a physician has an established relationship with the patient prior to ordering RPM services. The physician must evaluate the patient to understand the current medical status and needs of the patient prior to ordering RPM services and collect and analyze the patient’s physiologic data and to develop a treatment plan. CMS’ waiver suggests that during the PHE, practitioners may render RPM services without first conducting a new patient E/M service. Once the PHE ends, CMS will require that RPM services be furnished only to established patients.




Can I use a tele visit to initiate RPM for new patients ?


CMS allows for the use of real-time interactive audio-video technology to satisfy the face-to-face requirement for rendering E/M services. However, CMS has not published any guidance on using telehealth (i.e., audio-video technology) to conduct a new patient E/M service specific to enrolling a beneficiary in an RPM program. New patient E/M service codes (e.g., CPT Codes 99201-99205) are listed among the Medicare-covered telehealth services. CMS generally defers to state laws on doctors using telehealth.




Who can furnish RPM services and obtain consent?


CPT codes 99457 and 99458 can be furnished by a physician or other qualified healthcare professional, or by clinical staff under the general supervision of the physician. CPT code 99091 can only be furnished by a physician or other qualified healthcare professional.




Do I need to consent my patients for RPM services?


Yes.CMS requires patient consent for RPM services to be documented in the patient’s EHR. Patient consent can be obtained at the time RPM services are furnished. The consent can be obtained by individuals under contract with the billing physician or qualified healthcare professional. Although CMS did not directly address this in the final rule for the new codes, it is safe to assume CPT 99091 can likely be expected as a requirement for CPT codes 99453, 99454, and 99457.




How does CMS define Qualified Healthcare professional, Clinical Staff, and Auxiliary personnel ?


A physician or other qualified healthcare professional is defined as “an individual who is qualified by education, training, licensure/regulation (when applicable) and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.” When referring to a particular service described by a CPT code for Medicare purposes, a “physician or other qualified healthcare professional” is an individual whose scope of practice and Medicare benefit category includes the service and who is authorized to independently bill Medicare for the service. A clinical staff member is defined in the CPT Codebook as “a person who works under the supervision of a physician or other qualified healthcare professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service but does not individually report that professional service.” Auxiliary personnel include other individuals who are not clinical staff but are employees, or leased or contracted employees. As noted in the 2021 Proposed Rule, CMS supported its proposal under the idea that “the CPT code descriptors do not specify that clinical staff must perform RPM services.”




Can “ auxiliary staff ” furnish RPM services?


CMS allowed auxiliary personnel, in addition to clinical staff, to furnish services described by CPT codes 99453 and 99454 under the general supervision of the billing physician or practitioner. CMS also stated that RPM services are not considered to be diagnostic tests; they cannot be furnished and billed by an Independent Diagnostic Testing Facility on the order of a physician.




What does it mean to have an ‘interactive communication’ with a patient for CPT 99457 and 99458?


CMS stated that “interactive communication” for purposes of CPT codes 99457 and 99458 involves, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission. CMS stated the interactive communication must total at least 20 minutes of interactive time with the patient over the course of a calendar month for CPT code 99457 to be reported. CMS stated that each additional 20 minutes of interactive communication between the patient and the physician/nonphysician practitioner/clinical staff is reported using CPT code 99458. In support of this position, CMS indicated the CPT Codebook states that unless there are code- or code-range specific instructions, parenthetical instructions, or code descriptors to the contrary, time is considered to be the “face-to-face” time with the patient or patient’s caregiver/medical decision-maker. Because RPM is a service not typically furnished in person with the patient, CMS stated it interprets time in the 99457 and 99458 code descriptor to mean the time spent in direct, real-time interactive communication with the patient. The 20-minutes of time required to bill for the services of CPT codes 99457 and 99458 can include time for furnishing care management services as well as for the required interactive communication




Can I stack RPM and CCM codes?


The advance copy of CMS 2021 Final Rule directly conflicts with CMS’ Fact Sheet. On January 7, CMS confirmed that the Fact Sheet is correct. Providers can bill CMS both for interactive communications and remote care services rendered under CPT 99457 or 99458. For instance a provider can bill both CPT 99457 and CPT 99490 in the same month. This is allowed because CMS recognizes the kind of analysis involved in furnishing RPM services are complementary to chronic care management CCM and other care management services. However, time spent furnishing these services cannot be counted towards the required time for both RPM and CCM codes for a single month (i.e., no double counting). Accordingly, billing both requires at least 40 minutes total (20 minutes of CCM and 20 minutes of RPM).




What type of RPM devices qualify for Medicare purposes?


The CPT Codebook does not indicate that the RPM devices must be FDA-cleared, although such clearance may be appropriate. Nor does the RPM device need be prescribed by a physician, although this could be required depending upon the medical device. CMS states that RPM device should digitally (that is, automatically) upload patient physiologic data (that is, data cannot be self-recorded and/or self-reported by the patient).




How many days must the RPM device monitor per month?


The CPT indicates that monitoring must occur over at least 16 days of a 30-day period in order for CPT codes 99453 and 99454 to be billed. CMS stated that these two codes are not to be reported for a patient more than once during a 30-day period.




Can I bill CMS for using multiple devices given to one patient for RPM?


Even when multiple medical devices are provided to a patient, the services associated with all the medical devices can be billed only once per patient per 30-day period and only when at least 16 days of data have been collected. CPT 99453 can be billed only once per episode of care where an episode of care is defined as “beginning when the remote physiologic monitoring service is initiated and ends with attainment of targeted treatment goals.”




What are the RPM practice expense codes?


There are two practice expense only codes (99453 and 99454), valued to cover clinical staff time, supplies, and equipment, including the medical device for the typical case of remote monitoring. CPT code 99453 is valued to reflect clinical staff time that includes instructing a patient and/or caregiver about using one or more medical devices. CPT code 99454 is valued to include the medical device or devices supplied to the patient and the programming of the medical device for repeated monitoring. CMS stated that the medical device or devices that are supplied to the patient and used to collect physiologic data are considered equipment and as such are direct practice expense inputs for the code. Providers should always consult with their certified billing and coding professionals for proper Medicare device billing.




What is the RPM monitoring and management process?


This is the “order of events” for an RPM program. After analyzing and interpreting a patient’s remotely collected physiologic data, the next step is the development of a treatment plan informed by the analysis and interpretation of the patient’s data. At this point, the physician develops a treatment plan with the patient and then manages the plan until the targeted goals of the treatment plan are attained, which signals the end of the episode of care. CPT code 99457 and its add-on code, CPT code 99458, describe the treatment and management services associated with RPM. This suggests that Codes 99457 and 99458 cannot be billed until after the initial 30 day period of monitoring, as opposed to being billed simultaneously during the same time period.




What is chronic care management CCM?


CMS recognizes CCM as one of the critical components of primary care that contributes to better health and care for individuals, and holds promise for reducing overall health care costs. CCM can be used in many settings, including primary care, gerontology, and even in the hospital setting. Hospitals offering outpatient CCM services may bill Medicare under the Outpatient Prospective Payment System (“OPPS”) for the facility portion of the service. In addition, Medicare will pay for the physician/practitioner time directing the CCM services under the Physician Fee Schedule. CCM is another way health care providers and software companies can harness telemedicine technology to leverage staffing, improve patient care, increase doctor-patient contact, decrease inpatient length of stay, and ultimately reduce overall patient costs. The CCM and Complex CCM billing codes pay providers on a monthly capitated (per patient per month) basis. CPT 99490 allows eligible practitioners and suppliers to bill for at least 20 minutes of non-face-to-face clinical staff time directed by a physician or other qualified health professionals each month to coordinate care for beneficiaries who have two or more serious chronic conditions that are expected to last at least 12 months. CPT 99487 is for complex CCM that requires substantial revision of a care plan, moderate or high complexity medical decision making, and 60 minutes of clinical staff time. CPT 99489 is a complex CCM add-on code for each additional 30 minutes of clinical staff time. HCPCS G0506 is an add-on code to the CCM initiating visit for providing a comprehensive assessment and care planning to patients. (CPT 99487, 99489, and 99490 99491). For those CCM Services, CMS made an exception allowing incident to billing under general supervision. (“CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner), subject to applicable State law, licensure, and scope of practice. The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.”)




Can RPM CPT 99457 be billed “incident to”?


No. CPT code 99457 describes professional time and “therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services.” Notably different than Chronic Care Management (CCM) services (CPT 99487, 99489, and 99490). For those CCM Services, CMS made an exception allowing incident to billing under general supervision. (“CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an “incident to” basis (as an integral part of services provided by the billing practitioner), subject to applicable State law, licensure, and scope of practice. The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM.”)




Will Medicare Pay for Setting Up the RPM Device and Patient Education?


Yes. CPT 99453 offers separate reimbursement for the initial work associated with onboarding a new patient, setting up the equipment, and patient education on use of the equipment.




Must the Patient be in a Rural Area for RPM Reimbursement?


No, the patient does not need to be located in a rural area or any specific originating site. RPM is not considered a Medicare telehealth service. Instead, like a physician interpretation of an electrocardiogram or radiological image that has been transmitted electronically, RPM services involve the interpretation of medical information without a direct interaction between the practitioner and beneficiary. Medicare pays for RPM services under the same conditions as in-person physicians’ services with no additional requirements regarding permissible originating sites or rural geographies.




Does RPM Require a Face to Face Exam or Interactive Audio-Video?


RPM services do not require the use of interactive audio-video for established patients, as these codes are inherently non face-to-face. However, for new patients or patients not seen by the practitioner within one year prior to billing RPM, the practitioner must first conduct a face-to-face visit with the patient (e.g., an annual wellness visit or physical). E/M services levels 2 through 5 (CPT codes 99212 through 99215) should qualify for this face-to-face visit. Transitional care management (TCM) services should also qualify. However, services that do not involve a face-to-face visit by the billing practitioner or which are not separately payable under Medicare (e.g., online services, telephone and other E/M services) would not qualify as an initiating visit.




Is there a Patient Co-Payment for RPM Services?


Yes, as a Medicare Part B service, the patient is responsible for a 20% co-payment for RPM services. While several groups asked CMS to eliminate any beneficiary co-payment for RPM services, CMS explained that it does not have the authority to change the applicable beneficiary cost sharing for most physician services, including RPM. Providers are cautioned to bill the patient (or the patient’s secondary insurer) for the co-payment, as routine waivers of patient co-payments can present a fraud & abuse risk under the federal Civil Monetary Penalties Law and the Anti-Kickback Statute.




What other internet based CCM codes exist ?


Chronic Care Management offers a continuous care to patients with two or more chronic conditions. This is without the need for the patient’s face-to-face contact with the consulting physician or qualified healthcare professional. (99446- 9949, 99451, 99452, and Virtual patient check-ins with HCPCS code G2010. CPT 99446 (5-10 min) – $18.38 - 50% of time spent on “medical consult verbal or internet discussion CPT 99447 (11-20 min) – $36.40 - Same as above 50% ... CPT 99448 (21-30 min) – $54.78- Same as above 50% ... CPT 99449 (31 min or more) – $73.16- Same as above 50% ... CPT 99451 (5 min or more) -- $37.48- 50% on data analysis - written report required CPT 99452 - (16 mis or more) -- $37.48 -NA The CPT 99446 covers interprofessional telephone or internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional. This code requires 5-10 minutes of medical consultative discussion and review. The following codes cover the same service but are for longer periods of time: CPT 99447 requires 11-20 minutes of medical consultative discussion and review, CPT 99448 pays for 21-30 minutes of medical consultative discussion and review and CPT 99449 is for 31 minutes or more of medical consultative discussion and review. CPT 99451 is for interprofessional telephone/internet/electronic health record assessment and management services provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified healthcare professional. It requires 5 or more minutes of medical consultative time. Code 99451 is reported by the consultant, allowing them to access data/information through the electronic health record (EHR), in addition to telephone or internet consultation. It should be noted that code 99451 doesn’t include any verbal interaction between practitioners and can be accomplished with only a written report. CPT 99452 is for interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified healthcare professional. It requires a minimum of 16 minutes and can be billed every 14 days when this time requirement is met. Code 99452 is reported by the requesting/treating physician/QHP (e.g., the primary care physician). For CPT codes 99446-99449 and 99451: Can be claimed for new or established patients, for a new or exacerbated problem. They can be claimed by a consultant when requested by another physician/QHP. They cannot be claimed more than once per seven days for the same patient and cannot be claimed if the patient was seen by the consultant within the past 14 days.
Verbal patient consent is required for the interprofessional consultation from the patient/family documented in the patient’s medical record. The request and the reason for the request for the consult be documented in the record
Cannot be claimed if a transfer of care or request for or face-to-face consult occurs as a result of the consultation within the next 14 days. Must be claimed based on cumulative time spent, even if that time occurs on subsequent days Requesting/treating physician/QHP code 99452 is reported by the physician/QHP who is treating the patient and requesting the non-face-to-face consult for medical advice or opinion — and not for a transfer of care or a face-to-face consultation. Reported only when the patient is not on-site and with the physician/QHP at the time of the consultation. Cannot be reported more than once per 14 days per patient. Includes time preparing for the referral and/or communicating with the consultant for a minimum of 16 minutes.




Direct vs. indirect supervision ?


Direct supervision means the physician and auxiliary personnel must be in the same building at the same time (albeit not the same room). In contrast, general supervision does not require the physician and auxiliary personnel to be in the same building at the same time, and the physician could instead use telemedicine to exert general supervision over the auxiliary personnel.