The question that inevitably seems to get asked whenever incredible innovations are introduced in healthcare is “Who’s going to pay for it?” That question generally serves to throw a wet blanket over the enthusiasm for those new and better approaches.
But when it comes to telehealth and remote patient monitoring (RPM), CMS is increasingly raising its hand and saying, “we will.”
That’s certainly the case in 2020. CMS has said it will pay for several new CPT® codes that not only reimburse providers for various types of care they may already be providing in the interest of keeping patients healthier and out of the hospital; they also open new potential revenue streams to help ease the transition into value-based care.
Here are some of the most significant changes and additions providers should be aware of if they want to take advantage of new opportunities in telehealth and RPM.
CPT codes for physiologic monitoring
As most providers know, three new codes went into effect January 1, 2019. If you are not taking advantage of them in your RPM program you should be.
Code 99453 covers the set-up of devices in an episode of care (such as those used in Vivify’s RPM programs) and patient education, while code 99454 covers the cost of device(s) with daily recording(s) or programmed alert(s) and can be billed each 30 days.
Code 99454 covers the actual devices uses by the patient which supply daily biometric recordings and transmissions or program alerts and transmissions, and this can be billed every 30 days. This CPT code offers reimbursement for providing the patient with a device as defined by the FDA. We believe CMS may further define the device definition in 2020, but it currently remains very broad.
Code 99457 covers the first 20-minutes each calendar month of remote physiologic monitoring treatment management services, of clinical staff/physician/other qualified healthcare professional time requiring interactive communication with the patient/caregiver during the month.
But what about all the extra time these healthcare professionals spend working with patients participating in RPM programs? You know it happens.
The good news is CMS began paying for CPT code 99458 on January 1, 2020. The new code covers each additional 20 minutes (each calendar month) spent on treatment management services. Use 99458 in conjunction with 99457, which is a far more realistic reflection of what is required to properly manage an RPM program. Providers must remember, however, to bill against code 99457 for the first 20-minute time segment each month and do not report either of these codes for a time segment of less than 20 minutes
General supervision now allowed for 99457 and 99458
Another important change is that began January 1, 2020, CPT codes 99457 and 99458 will be designated as care management services by CMS, which means they can be furnished under general rather than direct supervision of the billing provider. The net effect is that the physician or other qualified healthcare professional supervising the delivery of RPM services doesn’t have to be located at the same site as the clinical staff actually delivering them.
Monthly telehealth clinical assessments for ESRD-related dialysis
The significant change here is that all patients with end-stage renal disease (ESRD) who are on dialysis can now receive their monthly clinical assessment from their nephrologist via telehealth from home.
End-Stage Renal Disease (ESRD)-related services are included in the monthly capitation payment of CPT codes: 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961.
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than 2 years of age to elderly in sequential age group codes, include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents and various services in CPT codes 90963 to 90970, removing a source of inconvenience for patients while enabling providers to potentially capture additional revenue.
Telehealth for opioid and substance abuse
Patients with substance abuse disorders (including opioid abuse), with or without a co-occurring mental health disorder, can also now be treated via telehealth from home rather that an office visit including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; These changes are covered under HCPCS codes G2086, G2087, and G2028. (Source: https://www.foley.com/en/insights/publications/2019/11/telehealth-medicare-2020-physician-fee-schedule).
Consolidation of consent for services
One other welcome change for 2020 is that the multiple forms that patients covered, under Medicare Part B had to sign to give their consent for various telehealth and RPM services, are now being consolidated into a single annual consent. That’s good news for patients, because it removes the hassles and confusion generated by having to sign multiple forms, and for providers because it eliminates duplicate paperwork.
The only caveat is that providers must explain what the patient’s co-pay will be – typically 20%. Of course, if the patient has a supplemental plan co-pay is likely to be $0.
More to the story
This blog post only scratches the surface of the changes and opportunities in telehealth and RPM for 2020. For a more in-depth look, please download our white paper “Moving Closer to Embracing Full Remote Care in 2020” or contact your Vivify representative.
CPT® is a registered trademark of the American Medical Association.”