New remote monitoring billing codes extend reimbursement at the start of the new year

New remote patient monitoring codes are temporary and time will tell if they become permanent coding options

The outbreak of COVID-19 has caused an increase in telehealth visits, with the last week of March 2020 seeing a 154% increase in computerized health care appointments compared to the same period the previous year. Data collected by McKinsey & Company suggests virtual health visits may be here to stay, with telehealth use stabilizing at levels 38 times higher than pre-pandemic rates. One of the factors credited for this continued increase is the expansion of reimbursable telehealth codes and the billing of remote monitoring.

CMS 2022 Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) determines how much healthcare professionals can be reimbursed for services rendered through its physician fee schedule.

According to the final rule for 2022 – which was released on November 2, 2021 – the CMS anticipates various telehealth services at least until the end of 2023. At that time, the inclusion of these services will be reviewed to determine s ‘they must remain on the program at all times.

Some of these reimbursable services fall under the category of “remote therapeutic monitoring” or RPM, creating new codes in the current procedural terminology (CPT) coding system. mHealth Intelligence reports that some of the new CPT codes involving remote monitoring of a patient’s musculoskeletal system include:

  • CPT code 989X1 – initial implementation of a health system and patient education in its use
  • CPT code 989X3 – supply of the device with programmed monitoring, every 30 days
  • CPT code 989X4 – interactive communication between the patient / caregiver and the healthcare professional, the first 20 minutes of the visit
  • CPT code 989X5 – interactive communication between patient / caregiver and healthcare professional, each additional 20 minutes

Advantages of the new monitoring codes

The creation of these new RPM codes allows chiropractic providers to continue providing care to patients who feel uncomfortable returning to the office without losing the ability to request reimbursement through Medicare or Medicaid.

These new codes also benefit patients, for example by removing cost barriers to treatment. When patients know that their visits will be covered by their federal insurance plan, they may be more likely to continue with their chiropractic protocol, as this has less of an impact on their monthly budget.

Healthcare IT News adds that by enabling greater use of virtual visits, CMS hopes to reduce costs spent on other types of more urgent medical care, such as emergency room visits, as well as prevent hospitalizations.

Potential disadvantages of RPM codes

It should be noted that there are certain conditions that must be met for redemption under these types of codes, which makes the process a bit more complex. For example, Foley & Lardner reports that in order for a device to be covered by Medicare, it must digitally download patient data. In other words, data cannot be self-reported or self-recorded. In addition, the device must collect patient data for at least 16 days per 30 day period.

In a document designed to help healthcare professionals better navigate the new codes, the American Medical Association adds that prior patient consent must be obtained before providing these services, as this consent is documented in patient records. In addition, some billing codes cannot be used in the same billing period, such as CPT code 99457 (20 minutes of interactive care) and CPT code 99091 (collection and interpretation of a patient’s physiological data).

The future of telehealth reimbursement

As these new remote patient monitoring codes are only in place until the end of 2023, only time will tell if they become permanent coding options. Factors that may contribute to the CMS decision at this time might include how often these telehealth visits are actually used and whether they are contributing to positive treatment outcomes.

If they remain permanent, a discussion will also likely open on guidelines around reimbursement for telehealth services for patient care. They may become less strict, leaving more flexibility to practitioners to decide what types of services their patients can benefit from the most.

About John Tuttle

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