Moving Away From Telemedicine & Telehealth CPT Codes for RPM in 2019

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Unbundling CPT code for Remote Patient Monitoring in 2018 was a good start, but we were very excited to see the Center for Medicare and Medicaid Services (CMS) formalize better payment for Remote patient monitoring in the CY 2019 Physician Fee Schedule Final Rule. For the last few days, there has been a lot of discussions, and still some confusion. For example, we expect additional guidance from CMS on what devices and technologies will qualify for these payments.

The American Medical Association (AMA) has already formalized CPT codes for Remote Monitoring of Physiologic Parameters:

  • 99453: Installation and training, one-time payment
  • 99454: Device(s) with daily recording or alert transmission, monthly payment
  • 99457: 20 minutes or more of treatment management services, monthly payment

Clinical staff can provide the service for CPT 99457, enhancing scalability, unlike the more restrictive CPT 99091.
We are also very fortunate that these new payments are not under Telehealth with its restrictions such as the requirement for a beneficiary to reside in a qualifying rural area.

This is by far the best article I have read on this new RPM payment from CMS, especially the reminder that as part of Medicare Part B, a co-pay applies, and the good news that the Chronic Care Management (CCM) codes (CPT 99487, 99489, and 99490) introduced in 2015 can be used for the same patient in the same month, if both time requirements are met. Be careful though, CCM can be provided “incident to” the provider, so you might need to change your workflow to meet the “clinical staff” requirements of the RPM codes.

The good news does not end here, CMS payments show the value of interactive technology with 2 new codes for interprofessional e-consults (99451,99452), and Virtual patient check-ins with HCPCS code G2010.

Home Health also gets some good news. CMS issued a final rule (CMS-1689-FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019.

This law moves home telehealth equipment from the administrative column to the allowable cost column on the cost report, thereby decreasing the cost burden of technology for Home Health Agencies.

Let us know how we can help you move forward, utilizing the appropriate technology to provide your best patient care.

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Vivify Health is transforming healthcare with the market’s most comprehensive patient-centered connected care platform, spanning from remote monitoring of high-risk patients and patient activation to population and employee health. Vivify’s platform is the digital pathway to collaborative care on demand — with a focus on ease of use for employees, members, patients and providers.

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