Article by Jordan Rosenfeld
With more than 40% of physicians reporting professional burnout, government payers hope reimbursement for remote patient monitoring might lift some of the administrative burden off their shoulders.
The U.S. is expected to be short some 120,0000 physicians by 2030, increasing the workload for practitioners who remain in the field. Remote patient monitoring stands to reduce physician workload by empowering patients to manage their own healthcare.
But most physicians have struggled to secure funds to purchase these new technologies, causing remote monitoring to become inaccessible to doctors outside research institutions and major hospital networks. Until now.
In an attempt to make it easier for physicians to receive reimbursement for time spent on these activities, CMS began offering billing codes to reimburse providers for care that falls under the RPM umbrella in 2018. RPM also overlaps with another Medicare program, Chronic Care Management (CCM), for patients with chronic illness.
According to Nancy Rowe, a certified professional medical coder and CEO of Practice Provider Corp in Hauppauge, New York, billing for these codes is not difficult, so long as providers keep good records in clinical visits.
As of 2019, three new RPM-focused CPT codes were issued for physicians or qualified healthcare providers to use. The codes are as follows:
- 99453: Patient set up and education. Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. Payment rate of $21.
This code can’t be reported more than once per episode of care, or for less than 16 days. It should also not be reported along with codes for more specific physiologic parameters, such as codes 93296 and 94760.
- 99454: Device and transmission of data. Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. Payment rate of $69.
This code includes professional time associated with initiating the device and accessing, reviewing and interpreting the data, as well as modifying care plans. It not be reported along with 99457.
- 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month. Payment rate of $54.
This code must be reported once every 30 days, no matter the number of parameters monitored. Physicians should not count any time spent on evaluation and management services or time related to other reported services. It should not be reported along with code 99091.
For all these codes, physicians must gain patient consent before billing for these services, Rowe explained, and they must be recorded in the patient’s medical record as well.
These codes must also be billed under direct supervision, which means that the physician is available onsite for any questions related to the service.
Rowe also made clear that these codes are time-based codes. “Physicians should indicate how much time was spent [on the RPM related activity].”
The RPM codes, Rowe said, are meant to be tracked for thirty day periods, and, “Whenever CMS puts out anything time based, you have to exceed fifty percent of that time,” she said. For example, a patient using RPM technology should have had a monitor or device available to them for at least 16 days out of the month. Similarly, she noted, “[A physician] wouldn’t dispense a monitor on the 29th and bill for a month.”
Because RPM is most commonly used to monitor hypertension, atrial fibrillation, diabetes, and even some cancers, some patients will participate in both chronic care and RPM treatment. Rowe pointed out that time spent charting and billing on both the RPM and the CCM must be kept carefully separate. “If enrolling in both programs, you have to document separately and the time can’t overlap,” Rowe said.
These codes are designed to make RPM more practical and efficiently executed within practices, and they are not subject to any of the restrictions that telehealth services are, which offers some flexibility.
CMS continues to recognize the value of RPM to the sustainability of the healthcare system. Rowe said that CMS has added new codes for 2020 that would allow for even more leeway in how physicians bill for RPM-related time.
Code 994X0 allows an additional 20 minutes of RPM time and pays $26.31. With this change, 40 minutes of RPM time would pay: $77.85
RPM codes 99457 and 994X0 will also fall under the General Supervision category, rather than Direct Supervision, as is currently required.
“[RPM] is a very new area of medicine and there are very few physicians actually doing it,” Rowe said. But CMS wants to motivate more physicians to use it. “CMS feels it’s better for patient care because there are so many non-compliant patients.”
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