Changes to Remote Patient Monitoring Billing Codes Dead, For Now

Those interested in seeing a number of changes to the current remote patient monitoring billing codes within the CPT set will have to wait a little bit longer. The American Medical Association's (AMA) CPT Editorial Panel failed to move on the changes, citing differences among panel members. The panel says that the proposed changes are dead, at least for now.

 

Panel members discussed the changes at their most recent meeting held in Chicago from May 9-11. This meeting was not the first at which changing remote patient monitoring billing codes had been discussed. Previous attempts have been made to enact changes, all with the same result. According to a Fierce Healthcare report, political turmoil within the panel has prevented the measure from moving forward.

Remote patient monitoring (RPM) codes are part of the CPT code set. Healthcare providers rely on them to bill for services related to remote monitoring and management of patient physiological data. The codes allow healthcare providers to build for a variety of services, including:

In essence, RPM codes offer the opportunity for healthcare providers to be reimbursed for the time, effort, and money they put into monitoring patients remotely. The concept behind remote monitoring and management is one of combining early intervention with proactive care between office visits. RPM is mainly for patients suffering from chronic conditions/diseases.

 

Among other things, the application to change RPM codes would have created two new billing options for remote monitoring. The first option would allow billing for 2-15 days of data collection and monitoring. The second would allow billing for 16-30 days. Using the second code would mean a higher reimbursement.

 

Why bother with new codes? According to the applicant, using current CPT codes, billing/reporting options can be a bit confusing. For example, CPT code 99454 is for 16-30 days only. As such, it can only be reported once every 30 days. Meanwhile, CPT code 99457 is based on the first 20 minutes of treatment management within a given calendar month.

 

Fierce Healthcare says that the application also calls for new supply codes for RPM and RTM devices. What that is all about is not exactly clear. What is clear is that the application failed yet again.

 

The AMA CPT Editorial Panel meets four times per year to review proposed changes to the CPT code set. Proposals are submitted by various interested parties, including third parties, by way of applications. Upon review, the panel can accept or reject a particular application. Applicants sometimes choose to withdraw their application and sometimes those applications are resubmitted at a later time.

 

If the panel agrees to a code change, the change then goes to the AMA Specialty Society RVU committee where it is evaluated for the time, work, and practice expense involved in the procedure - thus leading to potential pricing. Once a code is approved and scheduled for implementation, medical providers can begin preparations for adopting the changes. Such has been the hope with the RPM application over the last several panel meetings. But for reasons that have not been publicly disclosed in detail, these particular codes are not getting past the approval process of the panel.

 

This is the way things go with medical billing codes. Code sets are long and complex. Getting changes pushed through can be a challenging process. That is not necessarily a bad thing, however. More judicious changes help keep things under control, at least to some degree.