CMS Reimbursement Opportunities

Looking for information about the Centers for Medicare & Medicaid Services changes for RPM reimbursement? Here’s what we know so far about the announcement by CMS regarding  remote patient monitoring (RPM).

 

RPM has been shown to increase both the quality of care and patient satisfaction while simultaneously reducing the cost of care. In recognition, CMS has finalized three new codes (CPT 99453, 99454 and 99457) for 2019, which will enable healthcare providers to more readily adopt RPM and offer the full benefits to their existing patient populations with the financial support of CMS.

 

Previously, CMS unbundled remote patient monitoring from telehealth with a move to provide a temporary code, 99091, which is a transitional code to provide reimbursement specifically for remote patient monitoring programs. Currently code 99091 is defined as:

 

“Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (where applicable) requiring a minimum of 30 minutes of time.”

 

Three major RPM changes are:

 

1. CPT Code 99453 -Separate Payment for Initial set-up & 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.”

Currently CPT 99091 does not provide for reimbursement to providers for the time spent onboarding a new RPM patient. The new CPT code 99453 allows for additional reimbursement for the time spent with a patient for “initial set-up and patient education on use of equipment.” This sets the foundation for success and supports providers in their effort to implement RPM programs.

 

2. CPT code 99454 – Provides for billing for remote monitoring and adds clinical staff to allowed service providers

“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.”

CPT 99091 defined reimbursement for service by “physicians and other qualifed health care professionals.” Since RNs and other medical providers were not clearly authorized to bill for time spent delivering RPM service, physicians (or other qualified health care professionals) were required to spend 30 minutes per month per patient before they could bill. The new CPT  99454 explicitly adds clinical staff to those who are authorized to bill for service in addition to physicians/other qualified healthcare professionals.

 

3. CPT Code 99457 – Lower minimum treatment time required for reimbursement.

“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.”

As mentioned above, the current CPT 99091 requires a minimum of 30 minutes of service before billing can occur each month. The new CPT code 99457 reduces the minimum monthly billing time to 20 minutes.

 

As CMS continues to highlight the value of RPM as a valuable model of care, the new codes, (CPT 99453, 99454, and 99457),  cover installation and consent, the RPM derived patient-generated health data, and the interaction with a patient during the month. The MobileHelp strategic partnership with Lacuna Health offers a single source solution for hardware, software, and resources for organizations to maximize reimbursement opportunities without expanding staff.

 

Check back to our page for updates.

 

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