​2019 New CPT Codes Medicare Payments for Virtual Services Remote Monitoring InterProfessional Consultation

​2019 New CPT Codes Medicare Payments for Virtual Services Remote Monitoring InterProfessional Consultation

2019 New CPT Codes Medicare Payments for Virtual Services Remote Monitoring InterProfessional Consultation
2019 New CPT Codes Medicare Payments for Virtual Services Remote Monitoring InterProfessional Consultation

CMS – The Centers for Medicare & Medicaid Services (CMS) published the 2019 Medicare Physician Fee Schedule Final Rule, which includes a significant expansion of Medicare reimbursement for virtual (non-face-to-face) services furnished by physician practices in November 2018.

In the Final Rule, CMS noted “[i]n recent years, we have sought to recognize significant changes in healthcare practice, especially innovations in the active management and ongoing care of chronically ill patients. . . .” However, CMS’ efforts to promote these innovations have been limited by its interpretation of the statutory restrictions on Medicare reimbursement for telehealth services.

While CMS previously interpreted the geographic and site-of-service restrictions found in Section 1834(m) of the Social Security Act as applying to any virtual service, CMS now recognizes that these rules apply only “to a discrete set of physicians’ services that ordinarily involve, and are defined, coded, and paid for as if they were furnished during an in-person encounter between a patient and a healthcare professional.” By contrast, “services that are defined by, and inherently involve the use of, communication technology” are not subject to the Section 1834(m) restrictions. In making this distinction, CMS opened the door to new payment for remote patient monitoring (RPM), virtual check-ins, and interprofessional internet consultations.

Understanding Remote Patient Monitoring Services

This is what we know in 2018, Medicare began reimbursing for Remote Patient Monitoring using the CPT® code 99091.

Then, this year 2019, CMS will now reimburse for Remote Patient Monitoring using the new codes (see below) and in addition to the earlier CPT® code 99091

Let’s look at CPT Codes 99453, 99454, 99457

CPT® Code 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. Approximate Allowable/Reimbursement Fee Schedule: $21.00
CPT® Code 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. Approximate Allowable/Reimbursement Fee Schedule: $69.00
CPT® Code 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
Approximate Allowable/Reimbursement Fee Schedule: $54.00

Keypoints:

The first two codes are reimbursement for the practice expense associated with rendering the Remote Patient Monitoring or RPM services; no physician work is required to bill for either of this code.

  • Remember that the Remote Patient Monitoring Services may be billed for the same patient, on the same month as chronic care management (CCM) services, provided that the time spent for CPT® code 99457 is in addition to (and not the same as) the time spent for CPT® 99490, 99487, or 99489.
  • In the Final Rule, CMS summarized the numerous comments it received regarding the new Remote Patient Monitoring Services codes, especially that pertaining to what types of technology that meet the requirements/guidelines for Remote Patient Monitoring. CMS thus stated “to issue guidance to help inform practitioners and stakeholders on these issues.”
  • CMS offered no timeframe for the publication of such guidance. Without this guidance, providers likely will be unwilling to make investments in Remote Patient Monitoring programs.

Here comes the Virtual Check-Ins: Introducing HCPCS G2012!

In the past years, its been hard to get paid for separate payment for patient telephone calls that determines if an office visit or other service is justified. If the physician should want to see the patient, CMS considers the check-in as bundled into the service for the encounter.

Earlier this year, CMS acknowledged the problems this reimbursement model creates:

To the extent that these kinds of check-ins become more effective at addressing patient concerns and needs using evolving technology, we believe that the overall payment implications of considering the services to be broadly bundled becomes more problematic.

Effectively, the better practitioners are in leveraging technology to furnish effective check-ins that mitigate the need for potentially unnecessary office visits, the fewer billable services they furnish. Given the evolving technological landscape, we believe this creates incentives that are inconsistent with current trends in medical practice and potentially undermines payment accuracy.

In an effort to address these misaligned incentives, CMS now will pay for virtual check-ins using HCPCS G2012 (approximate allowable amount: $13).

The reimbursable service is narrowly defined:

Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified healthcare professional who can report evaluation and management E/M services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

CMS set the reimbursement for this service at approximately $15, citing “low work time and intensity.” For now, there are no frequency limits on this service, although CMS noted it may impose such limits if it detects over-utilization.

How about the Telephone calls that involve only clinical staff HCPCS Code G2012?

How about the Telephone calls that involve only clinical staff HCPCS Code G2012?

In the Final Rule, CMS clarified “that telephone calls that involve only clinical staff (cannot) be billed using HCPCS G2012, since the code explicitly describes (and requires) direct interaction between the patient and the billing practitioner.” Also, CMS elected to require “verbal consent that is noted in the medical record for each billed service” and to limit eligibility to established patients. In addition to reimbursement for synchronous communication, CMS will also pay for—under another new code, HCPCS G2010—remote evaluation of patient-submitted recorded video and/or images. This reimbursable service also is narrowly defined:

Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

CMS clarified that patient follow-up may take place “via any mode of communication, including secure text messaging, phone call, or live/asynchronous video chat, so as not to restrict a clinician’s interaction with patients.”

Again, the provider must document the beneficiary’s consent in the record (regardless of whether such consent is provided verbally, in writing, or by electronic confirmation) and eligibility is limited to established patients.

Use HCPCS Code G0071 for Virtual Communication Services

Use HCPCS Code G0071 for Virtual Communication Services

CMS also created a new HCPCS G0071 for virtual communication services furnished by a rural health clinic (RHC) or federally qualified health center (FQHC). Specifically, an RHC or FQHC may receive reimbursement for “at least 5 minutes of communication technology-based or remote evaluation services” furnished for a patient who has had an RHC or FQHC billable visit within the last year. This service is subject to the same limitations as HCPCS G2012 and G2010 with regard to prior and subsequent in-person visits. Payment for HCPCS G0071 is set at the average of the national non-facility payment rates for HCPCS G2010 and G2012.

CMS expects usage of virtual check-ins will be limited at first, “result[ing] in fewer than 1 million visits in the first year. . . .” However, CMS predicts usage of these services “will eventually result in more than 19 million visits per year. . . .”

Interprofessional Internet Consultation
Because specialists receive no reimbursement for time spent consulting with treating practitioners regarding specific patients, specialist input often requires scheduling a separate patient visit when telephonic or internet-based interaction between the specialist and the treating practitioner would suffice.
​CMS then Introduced the InterProfessional Consultations using a Six New Codes (see below)
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Remote Patient Monitoring Services

This is what we know. In 2018, Medicare began reimbursing for Remote Patient Monitoring using the CPT® code 99091. Then, this year 2019, CMS will now reimburse for Remote Patient Monitoring using the new codes (see below) and in addition to the earlier CPT® code 99091

Let’s look at our codes here:

CPT® Code 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment. Approximate Allowable/Reimbursement Fee Schedule: $21.00

CPT® Code 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. Approximate Allowable/Reimbursement Fee Schedule: $69.00

CPT® Code 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
Approximate Allowable/Reimbursement Fee Schedule: $54.00

Keypoints:

  1. The first two codes are reimbursement for the practice expense associated with rendering the Remote Patient Monitoring RPM services; no physician work is required to bill for either of this code.
  2. Remember that the Remote Patient Monitoring Services may be billed for the same patient, on the same month as chronic care management (CCM) services, provided that the time spent for CPT® code 99457 is in addition to (and not the same as) the time spent for CPT® 99490, 99487, or 99489.

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Ms. Pinky, as she is fondly called - is a Reputable Professional Consultant and Expert in Practice Administration, Medical Billing, Coding, Health Information Technology, Insurance Credentialing and Compliance for Physician Offices. Well-educated with a Degree in Computer Systems Engineering and a background in Clinical Nursing and Small Business Management. Her professional mission is to make sure her clients/physicians maximize reimbursement while they remain compliant with the current rules, changes, guidelines and policies. Read More About Ms. Pinky here and See what Other's say about her Expertise Testimonials

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