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99091: New Telehealth CPT Code for Remote Patient Monitoring?

Remote Patient Monitoring

Remote patient monitoring (RPM) is the term used to refer to a broad range of technologies that allow clients/patients to be monitored when in non-professional settings, such as their homes, at work, and even at play. While such systems have been at the periphery of telehealth for almost two decades, they now can be brought into the mainstream of telehealthcare by allowing a client or patient to monitor their own behavior (thoughts) or bodily processes (heart rate, temperature, etc.) continuously, that is, throughout the day. 
 
Such technology allows the patient to increase access to care while decreasing healthcare delivery costs (i.e., taking time from work, paying for childcare, travel expenses, waiting to be seen by a professional). RPM allows clients and patients to maintain independence, prevent complications, and minimize personal costs associated with healthcare. Expected benefits include: 
  • Identifying at-risk patients
  • Improving outcomes, and 
  • Ultimately becoming part of the standard of care to improve health and efficiency
  • Allowing patients to take an active role in their health
  • Allowing practitioners to detect problems early rather than allowing costs and complications to escalate, particularly with chronically patients.  
  • Providing meaningful technology to support a reasonable transition to value-based care
  • Support the spirit and mission of patient center-care 

Actual Fees

The un-bundled CPT code 99091 in 2018 means that Medicare will pay for CPT code 99091 with an unadjusted reimbursement rate of $58.67 per month.

Guidelines 

  • Providers must obtain advance beneficiary consent for the service and document this consent in the patient’s medical record.
  • For new patients or those not seen within one year before the provision of remote monitoring services, providers must initiate these services in a face-to-face visit, such as an annual wellness visit or physical.
  • Providers can use 99091 no more than once in a 30-day period per patient.
  • The code includes time spent accessing the data, reviewing or interpreting the data, and any necessary modifications to the care plan that result, including communication with the patient and/or her caregiver and any associated documentation.
  • This code will not be subject to any of the restrictions on originating sites or technology that telehealth services are subject to by CMS statute, allowing users of this technology more flexibility.

Other 2018 CPT Codes for Telehealth1

CMS has also included several new services for 2018 that will be reimbursed when performed using telehealth: 

  • Counseling visit for lung cancer screening (HCPCS code G0296)
  • Psychotherapy for crisis (CPT codes 90839 and 90840)
  • Interactive complexity (CPT code 90785)
  • Patient-focused and caregiver-focused health risk assessment (CPT codes 96160 and 96161)
  • Chronic care management services including assessment and care planning (HCPCS code G0506)

In 2018, remote patient monitoring (RPM) and other telehealth services (crisis intervention) were also approved for reimbursement by Medicare. Details of those CPT codes can be found on this Centers for Medicare and Medicaid (CMS) document. Once you open that CMS “2018 Final Rule” document, look for the section that starts on page 8, and which is highlighted in yellow for your convenience.

 

1Each of these new services is must adhere to existing statutory conditions for telehealth, including requirements for use of interactive telecommunications systems and originating site restrictions.

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