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While some aspects of telehealth may be simple, determining reimbursement for telehealth services is not. Some CPT codes are extremely specific, designating a treatment for a patient of a specific age, condition or length of time, while others are more vague.
For 2019, the American Medical Association added three new CPT codes that open more avenues for payment. These codes expand remote patient monitoring services, making it easier to provide and get paid for your telemedicine care. Though the Center for Medicare and Medicaid Services did not incorporate these codes into their list of telehealth services for 2019, many private insurers will use these codes for reimbursement.
They also separate remote patient monitoring from telehealth. This means the services no longer fall under the originating-site statutory restrictions that required patients to be in a rural area or at another approved site. You can use these remote patient monitoring codes for patients who live anywhere.
Please note that the codes below containing an X are placeholders. Specific new codes should be available in the 2019 CPT Datafiles.
CPT 990X0
This code covers the initial set-up and patient education required to being remote patient monitoring. The monitoring must be of physiologic parameters such as weight, blood pressure, pulse oximetry, etc.
Why this code matters: This new code allows you to be reimbursed for time that previously was uncovered. Set-up and education can take up hours of time for your nurse or physician; now you can cover those costs more effectively.
CPT 990X1
This code covers the initial transmission, collection and reporting of patient information to a physician. Again, it can only be used for monitoring of physiologic parameters.\
Why this code matters: Again, this code helps offset the initial costs of starting remote patient monitoring services.
CPT 994X9
This code covers interaction with the patient after data has been collected. This may be an appointment to change the care plan or discuss successful treatment.
Why this code matters: This code helps provide payment to your clinicians who can bill for time, such as physicians or nurse practitioners. It also helps ensure you provide face-to-face follow-up with patients, which is good standard of care.
WHAT YOU SHOULD KNOW
All three codes do come with certain stipulations:
A physician or other qualified health professional (such as a physician assistant or nurse practitioner) must provide the data interpretation, which should take at least 30 minutes.
You must have consent for this service in advance from Medicare beneficiaries and document the consent in patients’ medical records.
You must start the remote patient monitoring service during a face-to-face visit with the clinician who will be billing for the service. This could be during an annual Medicare wellness visit or the initial Medicare preventive physical exam.
You can only report the code once in each 30-day period. The code must be related to the data acquisition, review, or modification of the care plan, and you must include documentation to show that was the case.
The AMA and private payors are beginning to understand the value of remote patient monitoring and its ability to prevent ER visits and hospital stays. As more data shows the financial benefits of these low-cost programs, payment is expected to expand.
Get help navigating new codes and payor requirements. Datapro can help you reduce claim errors and receive more reimbursement for the care you provide. Contact us today to learn more.
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