CMS (Centers for Medicare & Medicaid Services) just announced the 2021 Physician Fee Schedule with important updates to Remote Patient Monitoring (aka “RPM” or “Remote Physiologic Monitoring”) and it has some important changes that all RPM providers should know.
RPM readings can not be self-reported
CMS clarified that RPM solutions that involve patients just self-reporting their physiologic data, as opposed to their device uploading or sending the data automatically by cellular or Bluetooth, for example, do NOT qualify for RPM.
There is no change to Accuhealth services. All of our devices automatically transmit the data to our platform without the need of any additional technology for the patient.
Time for 99457 and 99458 does NOT have to be ONLY interactive phone or video time
Although CMS had proposed that the time that was spent to qualify for codes 99457 and 99458 might have to be limited to only time spent actually talking with patients, as opposed to time spent reviewing data, comparing to previous readings, etc., CMS has now clarified that time spent towards codes 99457 and 99458 can include time spent for furnishing care management services as well as the required interactive communication.
Good news! Providers can bill for 99091 in the same 30-day period as 99457 earning an additional ~$57 per month for the physician.
This is a big surprise because the CPT Codebook clearly says, “Do not report 99091 in conjunction with 99457,” but then CMS clarifies, “We note that these two statements suggest that there may be instances where both codes could be billed for the same patient in the same month as long as the same time was not used to meet the criteria for both CPT codes 99091 and 99457.”
Keep in mind that 99091 requires 40 min of physician or NPP (non-physician provider) time and can not be delegated to other staff or vendor partners the way 99457 can.
“We remind readers that the valuation for CPT code 99091 includes a total time of 40 minutes of physician or NPP work broken down as follows: 5 minutes of pre-service work (for example, chart review); 30 minutes of intra-service work (for example, data analysis and interpretation, report based upon the physiologic data, as well as a possible phone call to the patient); and 5 minutes of post-service work (that is, chart documentation).”
This is fantastic news for our providers! Accuhealth will not charge for this code if the physician is able to meet the requirements, which means more money in your pocket. Make sure to track your time to ensure you collect for this code where applicable.
After the COVID-19 Public Health Emergency period ends, CMS will require that patients have at least 16 reading days per 30-day period in order to bill for 99453 and 99454. It is disappointing that CMS made this decision, since not all patient scenarios require this many reading days. Nonetheless, Accuhealth is already preparing for this new requirement by building out even more patient engagement tools and automations for patient adherence.
As a result of this 16 reading minimum, it is very important all clinics and physicians reiterate to their patients to take readings everyday as this data helps them help you!
With the exception of the 16-reading minimum, Accuhealth is delighted with the new changes. We will continue to deliver world-class service to your clinic, allowing you to bill using the RPM codes and provide the industry’s best remote care for your patients.
RPM and remote care services are the future. This program is clearly successful and only getting more comprehensive over time.