New remote monitoring billing codes expand reimbursement entering new year

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

The appearance of COVID-19 caused a spike in telehealth visits, with the last week of March 2020 seeing a 154% increase in computer-based health care appointments over the same period of time the year before. Data collected by McKinsey & Company suggests that virtual health visits may be here to stay, with the utilization of telehealth stabilizing at levels that are 38 times higher than pre-pandemic rates. One of the factors credited for this continued increase is the expansion of reimbursable telehealth codes and remote monitoring billing.

CMS’s 2022 physician fee schedule

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

According to the final rule for 2022 — which was released Nov. 2, 2021 — the CMS provides for various telehealth services through at least the end of 2023. At that time, the inclusion of these services will be revisited to determine if they should remain on the schedule permanently.

Some of these reimbursable services fall under the category of “remote therapeutic monitoring” or RPM, creating new codes within 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 set-up of a healthcare device and patient education regarding its use
• CPT Code 989X3 – device supply with scheduled monitoring, every 30 days
• CPT Code 989X4 – interactive communication between the patient/caregiver and the health care professional, first 20 minutes of the visit
• CPT Code 989X5 – interactive communication between the patient/caregiver and the health care professional, each additional 20 minutes

Benefits of new remote monitoring codes

The creation of these new RPM codes enables chiropractic providers to continue to provide care to patients who don’t feel comfortable returning to the office without losing the ability to submit for reimbursement through Medicare or Medicaid.

These new codes benefit patients as well, such as by removing cost-related barriers to treatment. When patients know that their visits will be covered through their federal insurance plan, they may be more likely to continue with their chiropractic protocol since it has less impact on their monthly budget.

Healthcare IT News further adds that by allowing for greater use of virtual visits, the CMS hopes to lower the costs spent on other types of more urgent medical care, such as visits to the emergency room, as well as also preventing hospitalizations.

Potential drawbacks of RPM codes

It should be noted that certain qualifications must be met for reimbursement under these types of codes, making the process a bit more complex. For instance, Foley & Lardner reports that, for a device to be covered by Medicare, it must digitally upload patient data. In other words, the data cannot be self-reported or self-recorded. Additionally, the device must collect patient data at least 16 days per 30-day period.

In a document designed to help health care practitioners better navigate the new codes, the American Medical Association adds that advanced patient consent must be obtained before supplying these services, with such consent being documented in the patients’ records. Plus, certain 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 physiologic data).

The future of telehealth reimbursement

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

Should they remain permanent, a discussion will also likely commence as to the guidelines surrounding the reimbursement of telehealth services for patient care. Perhaps they will become less stringent, allowing for greater latitude for practitioners when deciding what types of services their patients can benefit from most.