December 19, 2018

Many members of the Life365 team, including our CEO, Kent Dicks, have been developing tele-monitoring/ remote patient monitoring solutions, together, for more than 12 years. This was before Meaningful Use was introduced, and before electronic medical records were required to be implemented (by 2014) as part of the American Recovery and Reinvestment Act of 2009. Throughout this time, we have seen legislation, reimbursement, and technology change. It has been a journey helping to educate decision makers on the benefits of remote health monitoring; we have testified before congress, we’ve helped shape policy and reimbursements through participation with the Connected Health Initiative and other groups, and are active members of various industry groups like the American Telemedicine Association and telehealth resource centers.

We have seen positive advancements that support the implementation, use, and development of connected health technologies, and the proposed changes to the 2019 Medicare Physician Fee Schedule is definitely a step in the right direction. We’ve summarized some information below on the new codes for Chronic Care Remote Physiologic Monitoring, outlining how providers can implement digital health tools, and receive reimbursement, for remote patient monitoring.
 

2019 Chronic Care Patient Monitoring Codes

 
Chronic Care Remote Physiologic Monitoring (CPT Codes 99453, 99454, and 99457)

  • CPT code 99453 (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) $19.46
  • CPT code 99454 (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) $64.15
  • CPT code 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) $51.54

Some notable improvements from previous rules include:

  • Reimbursement for the time spent preparing devices & health kits for patients and training patients on how to use the technology, applications and devices.
  • CPT Code 99457 allows services to be performed by “clinical staff” as well as physicians and other qualified health care professionals. The term “clinical staff” was not included in 2018 unbundled CPT code 99091 (which was 16 years old!). Clinical staff could include, for example, RNs and Medical Assistants. All practitioners must practice in accordance with applicable state law and scope of practice laws.
  • CPT code 99457 is billed based on a calendar month, not a 30 day period. This is much easier for tracking and claims submissions.
  • Compared with the 30 minutes of time required for CPT 99091, CPT 99457 only requires 20 minutes of interactive communication with patient/caregiver.

The patient must consent to participating in remote patient monitoring services, and if the patient is new, or has not been into the clinic in over a year, a face-to-face visit is required, for example, for an annual wellness visit.

CPT 99457 & CPT 99490 Chronic Care Management (CCM) can both be billed in the same month, however, time cannot be “double counted.” It must be 20 minutes for each, for a total of 40 minutes.

The AMA has urged CMS to adopt the new codes for remote patient monitoring, AMA President Barbara McAneny, M.D., stated, “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care.”

We couldn’t agree more! Remote monitoring is an opportunity to implement new care delivery models and provide guidance & support to patients outside of the traditional care setting. There are still some changes that we would like to see, including the ability for remote patient monitoring services to be billed “incident to”, which is currently allowed for CCM services. These types of models can speed up adoption, and enable more practices to participate, which leads to more patients whom are able to receive the benefits of remote monitoring. Another way to promote adoption would be the elimination of a patient co-payment for RPM services, which is 20%, as a Medicare Part B service.

Find the published, finalized rule for the 2019 Physician Fee Schedule, here.