Options for Remote Patient Monitoring and Treatment Services
New CPT codes are now available in 2019 to provide additional opportunities for remote monitoring of patient health data and reimbursement.
Previously, CPT 99091 was available for remote patient monitoring: Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.
The new codes — 99453, 99454 and 99457 — involve using a device to track a patient’s important health metrics, such as blood pressure or weight, assess a patient’s chronic condition or monitor treatment management. These codes require less time, allow reimbursement for initial set up and education, are not limited to physicians only, and offer billing on a monthly rather than 30-day period basis. These services are distinct from telehealth services and do not require face-face-face interaction though patients are expected to be established patients seen by the practitioner face-to-face within one year prior. Patient cost-sharing such as co-payments, etc still apply. In addition, the specific types of technology have not been elucidated.
The codes pertain to various layers of remote monitoring. The code descriptors read as follows:
- 99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
- 99454 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
- 99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
In the future, we expect further guidance from CMS to help determine the scope of services and better interpret the code descriptors, such as types of technology.
Time should be taken to understand these CPT codes and use them properly.