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Objective:Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic’s standard of care. Methods:We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers’ licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot. Results:We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence. Conclusions:Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM.
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This content will become publicly available on June 1, 2026
Preventing Urgent Pediatric Readmissions: The Need for and Promise of Real-Time Monitoring
Abstract Urgent pediatric hospital readmissions are common, costly, and often preventable. Existing prediction models, based solely on discharge data, fail to accurately identify pediatric patients at-risk or urgent readmission. Remote patient monitoring (RPM) leverages wearable technology to provide real-time health data, enabling care teams to detect and respond to early signs of clinical deterioration. Emerging evidence suggests RPM may be a promising strategy to improve pediatric postdischarge outcomes and reduce urgent hospital readmissions.
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- Award ID(s):
- 2205084
- PAR ID:
- 10621802
- Publisher / Repository:
- JMIR
- Date Published:
- Journal Name:
- JMIR Pediatrics and Parenting
- Volume:
- 8
- ISSN:
- 2561-6722
- Page Range / eLocation ID:
- e60802 to e60802
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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