CMS opened the door to reimbursement for remote patient monitoring in 2018 and 2019 through additions to the Current Procedural Terminology (CPT) codes. These additions were built around analyzing and interpreting physiologic data collected remotely.
Using the correct CPT codes ensures your remote monitoring program is effective and profitable. Learn how you can take advantage of these reimbursement codes for telehealth.
Reimbursement
While remote patient monitoring (RPM) technologies have been rapidly deployed to support social distancing during the COVID-19 pandemic, reimbursement barriers prevent widespread adoption. While several Medicare CPT codes provide financial structure for medical and clinical services delivered remotely, until recently, codes specific to remote physiologic monitoring were not available.
CMS has introduced new CPT code 99457 and its add-on code 99458, which reimburses monthly for the first 20 minutes a physician or nonphysician-qualified health professional spends checking readings from a device, speaking with a patient to coordinate treatment plans, or developing educational materials. The code requires interactive communication between the provider and patient, meaning clinicians should consider their scope of practice and state laws before utilizing this service.
These new RPM CPT codes should be combined with Chronic Care Management (CCM) principles to optimize reimbursement and make it more worthwhile to offer remote monitoring. Learn more about how to utilize RPM with CCM here.
Patient Satisfaction
The CMS’s new remote patient monitoring CPT codes offer a new way for practices to make RPM more financially viable. However, rules should work with a billing practitioner to ensure they correctly code care.
These management CPT codes (99457 and 99458) require that a physician or qualified healthcare professional check readings, speak with the patient or caregiver, and coordinate treatment plans remotely. This may also include reviewing patient data or developing educational materials. Additionally, these services must be provided for at least 20 minutes per month.
The ambiguity around these codes and the definition of “physiologic” has confused the reimbursement community and has been a barrier to adopting these technologies. However, the recent granting of enforcement discretion for physicians to use popular communication programs during the COVID-19 national emergency will likely accelerate the adoption of these technologies. It will also allow for more equitable access to these digital tools.
Patient Engagement
RPM billing codes help providers and healthcare organizations get reimbursed for deploying a remote patient monitoring platform. These codes are critical to the growth of this emerging digital healthcare technology.
Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic procedures performed in the US and serve as a foundation for reimbursement and tracking utilization. Before 2018, no CPT code existed for remote physiologic monitoring services.
In the 2021 Physician Fee Schedule final rule, CMS introduced CPT codes 99453 and 99454 to monitor a patient’s physiologic data remotely. These services are considered evaluation and management (E/M) services, which physicians and certain qualified healthcare professionals like nurse practitioners and physician assistants can only bill.
These new codes require a minimum of 16 days of monitored data to be reported. Although CMS waived the requirement during the COVID-19 pandemic, this will not apply beyond it. The agency’s proposal to replace these existing codes with G-codes—which nonphysician health care professionals could furnish—was not included in the 2023 PFS proposed rule, which may signal that it will be reconsidered in the future.
Data Collection
RPM-generated data is enormous, and practical filters must relay only high-yield information to physicians. Moreover, managing this deluge will require creating new tools for collecting, processing, and interpreting big data.2
In 2023’s home health PFS final rule, CMS made it easier for Medicare home health providers to use telehealth technology by creating new remote physiologic monitoring CPT and HCPCS G-codes. The code descriptors suggest that CCM and RPM require interactive communication with the patient, which differs from how CMS defines similar services, such as RCM and E/M visits.
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