CMS won’t release the 2020 Medicare Physician Fee Schedule final rule until later this fall, but that doesn’t mean you should wait to shore up your reimbursement for coding remote patient monitoring based on the proposed rule.
Released in July, the proposed rule contains important clues about what you can expect next year. And even if you don’t treat many Medicare patients, private payers often follow CMS’s lead. This year, two of the most significant changes in the 2020 MPFS proposed rule relate to coding remote patient monitoring services:
- A revised code description for 99457 would allow auxiliary staff to provide remote patient monitoring services to be under general supervision instead of direct supervision (the physician and staff member providing the service do not have to be in the same building at the same time).
- New code 994X0 would be used as an add-on code for patients who received more than 20 minutes of remote patient monitoring treatment as provided for in code 99457.
CMS intends for these two updates for coding remote patient monitoring to provide additional clarity, flexibility, and billing opportunities for providers. If this sounds familiar to you, it is. Over the past few years, coverage for telehealth services — including remote patient monitoring — from both federal and private payers has expanded. For example, at the beginning of 2019, CMS implemented three new CPT codes* for remote monitoring services in addition to the existing code 99091:
- 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)
- 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)
- 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)
*Note: You may not bill any of these three codes in conjunction with 99091.
New Codes for Remote Patient Monitoring Encourage Adoption
The new telehealth codes from 2019-2020 could incentivize providers who are not currently using remote patient monitoring in their practice to start doing so by making it easier and more profitable to provide those services. For example, consider these positive changes for coding remote patient monitoring services:
- Unlike 99091, code 99453 offers separate reimbursement for the initial setup of remote patient monitoring equipment and time spent educating the patient on its use. An in-person visit is not required to bill 99453.
- While code 99091 required a treatment time (with interactive communication) of at least 30 minutes per each 30-day period, code 99457 requires only 20 minutes per calendar month (33 percent less time). For additional minutes beyond 20, providers would bill proposed code 994X0. Keep in mind that 16 days of service are required to bill a monthly period.
- Unlike other telehealth services where the patient must be located in a specific place in order to bill for the services, RPM is not subject to any location restriction.
- All of the new codes allow for asynchronous (aka store-and-forward) communication between patients and providers. Previously, providers could only bill for synchronous telehealth services (where the patient and provider are face-to-face such as a video chat).
- Patients do not have to be located in a Health Professional Shortage Area (HSPA) for remote monitoring, like they do with other types of telemedicine.
It’s only gotten easier for providers to reap the financial benefits of billing for remote monitoring. However, many providers are still unaware of this revenue stream that’s available to them. They don’t have the equipment or set-up necessary to code for remote monitoring.
And those providers that are aware are often not coding and billing their claims correctly to receive the maximum reimbursement.
Find out how you can finally get paid more of what you deserve when coding Remote Patient Monitoring services that your physician and medical assistants provide by attending this 60-minute online training session presented by national coding expert and educator, Penny Osmon Bahr, CHC, CPC, CPCI.
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