RPM + Geriatrics
Remote Patient Monitoring for Geriatrics — Epic + CCN Health
Specialized RPM protocols for Geriatrics — integrated with Epic, powered by CCN Health. Evidence-based workflows, automated documentation, and Medicare billing.
CCN Health provides a certified Remote Patient Monitoring (RPM) integration with Epic optimized for geriatrics practices. The platform automates clinical documentation, enables real-time monitoring, and generates Medicare billing records for compliant reimbursement.
Remote Patient Monitoring for Geriatrics with Epic
CCN Health's RPM program integrates with Epic to provide geriatrics-specific clinical protocols, device monitoring, and automated Medicare billing for geriatrics patient populations.
Geriatrics Conditions Managed
- Multi-morbidity
- Frailty
- Polypharmacy management
- Fall prevention
- Cognitive decline
- Malnutrition risk
Clinical Protocols
- Comprehensive vital sign monitoring across multiple conditions
- Fall risk assessment and continuous monitoring
- Medication management with polypharmacy review
- Functional status tracking for aging-in-place support
Key Monitoring Metrics
| Metric | Clinical Significance |
|---|---|
| Blood pressure | Tracked and trended for geriatrics management |
| Weight | Tracked and trended for geriatrics management |
| Heart rate | Tracked and trended for geriatrics management |
| SpO2 | Tracked and trended for geriatrics management |
| Activity levels | Tracked and trended for geriatrics management |
| Sleep patterns | Tracked and trended for geriatrics management |
Recommended Devices for Geriatrics
| Device | Use Case |
|---|---|
| Blood pressure monitor | Geriatrics monitoring |
| Weight scale | Geriatrics monitoring |
| Pulse oximeter | Geriatrics monitoring |
| Xandar Kardian sensorless | Geriatrics monitoring |
| Fall detection sensor | Geriatrics monitoring |
Relevant ICD-10 Codes
- R54 (Age-related physical debility)
- R26.x (Abnormalities of gait and mobility)
- Z73.x (Problems related to life management)
- R41.x (Cognitive function symptoms)
Clinical Evidence
Comprehensive geriatric monitoring programs reduce hospitalizations by 20-35% and support longer independent living periods in senior populations.
Billing & Reimbursement
| CPT Code | Reimbursement | Requirements |
|---|---|---|
| 99453 | ~$19 | One-time device setup and patient education |
| 99454 | ~$50/mo | 16+ days of readings per 30-day period |
| 99457 | ~$48/mo | First 20 minutes of clinical monitoring time |
| 99458 | ~$38/mo | Each additional 20 minutes of clinical time |
Monthly potential per patient: $120+
Frequently Asked Questions
How does RPM support geriatrics practices?
CCN Health's RPM integration provides geriatrics-specific monitoring protocols, automated documentation in Epic, and compliant Medicare billing for multi-morbidity and related conditions.
What devices are recommended for geriatrics RPM?
For geriatrics patients, CCN Health recommends blood pressure monitor, weight scale, pulse oximeter based on the specific conditions being managed.
Can RPM data integrate with specialist workflows?
Yes. All RPM data flows into Epic and is available for specialist review, care plan updates, and cross-program coordination.
Geriatrics
Geriatrics Protocols — clinical workflows configured to evidence-based guidelines and risk thresholds.
Specialist Coordination — automated alerts and reporting to referring specialists and primary care teams.
Outcome Tracking — longitudinal vitals data mapped to Geriatrics-specific quality measures.
Clinical Documentation — automated notes that satisfy specialist coding and audit requirements.
Purpose-built for Geriatrics workflows — integrated with the EHR your facility already uses.
Book a Discovery CallAI-Powered Alerts
Pattern recognition catches changes early
Smart Workflows
Automated routing and documentation
Automated Compliance
Real-time audit trail and billing validation
Advanced intelligence working behind the scenes — faster processing, smarter alerts, effortless documentation.


Technology that stays in the background — so care stays in the foreground.
Why CCN Health
Why Geriatrics Programs Choose CCN Health
Purpose-built technology that fits your clinical workflows and drives measurable outcomes.
Seamless EHR Integration
How CCN Health Works Inside Epic
Your monitoring data flows directly into Epic — no exports, no manual entry, no disruption to your clinical workflow.
RPM Devices
CGM, Scales, BP, SpO2
AI-Powered Platform
Intelligent data routing, anomaly detection, and automated documentation — working behind the scenes.
Epic
Charts & Care Plans
What Flows Between Systems
Patient Demographics
Conditions, medications, and census sync from your EHR
Vital Observations
Device readings flow automatically into patient charts
Discharge & ADT Events
Admission and discharge events trigger protocol changes
Care Plans
Treatment plans inform monitoring thresholds and alerts
Billing Documentation
CPT-ready records generated for claims submission
Cross-Program Data
RPM data available for CCM, PCM, BHI — no re-entry
“Every reading, every alert, every care plan update — available across all your programs. One integration, unlimited use cases.”
Infrastructure
Devices & Billing
FDA-cleared devices and automated Medicare billing — configured per patient, synced with the EHR.
Supported Devices
The Xandar Kardian sensor captures heart rate, respiratory rate, and room presence using radar technology — residents don't wear, charge, or interact with anything.
Medicare Billing
Remote Patient Monitoring (RPM)
4 billing codes
Initial setup and patient education on monitoring equipment
~$19
One-time
Device supply with daily recording or programmed alert transmission
~$50
Monthly
First 20 minutes of clinical staff time for RPM treatment management
~$50
Monthly
Each additional 20 minutes of RPM treatment management
~$40
Monthly (additional)
Common Questions
Frequently Asked Questions
Everything you need to know about Geriatrics — implementation, billing, and clinical workflows.
Yes. CCN Health integrates with Epic via secure APIs, enabling RPM device data and care management documentation to flow into Epic's enterprise health records.
CCN Health transmits device readings and care coordination notes to Epic through FHIR-based APIs, ensuring clinical data is available within existing Epic workflows.
RPM uses FDA-cleared connected devices to collect patient vitals—such as blood pressure, weight, and glucose—outside of traditional clinical settings, enabling proactive care and early intervention.
The primary RPM CPT codes are 99453 (device setup), 99454 (monthly device supply/data transmission), 99457 (first 20 min clinical review), and 99458 (each additional 20 min).
Most facilities are fully operational within 2–4 weeks. CCN Health handles device provisioning, EHR integration setup, staff training, and ongoing clinical support.
Still have questions? We're happy to walk you through anything.
Talk to Our Team