In July 2019, the CMS proposed new rules and reimbursement codes for the Chronic Care Management program and Remote Patient Monitoring services. It solicited the wider healthcare community for comments before releasing its 2020 Physician Fee Schedule. The CMS finalized 2 changes that were originally proposed, both of which will go into effect on January 1, 2020. Both changes are related to remote patient monitoring services.
New CPT code 99458 to pay for additional RPM time
In January 2019 a new CPT code 99457 went into effect that reimburses qualifying practitioners for remote physiologic monitoring treatment management services performed by clinical staff, physician, or other qualified HPC that required at least 20 minutes of their time during the billing month. The new CPT 99458 is effectively an “add-on” code that will reimburse for an additional 20 or more minutes beyond the initial 20 minutes covered by CPT 99457. The new description of both codes is:
- CPT code 99457 (Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes)
- CPT code 99458 (Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes)
- From January 2020, practitioners will utilize the CPT 99458 for patients who received the remote physiologic monitoring treatment management service amounting to 40 minutes or more in any given month. The CMS clarified their stance on RPM billing for RHCs and FQHCs stating these organizations are not eligible to bill these codes because they are already included in the RHC all-inclusive rate or FQHC prospective payments.
- CPT Codes for CCM- The CMS made it clear that it continues to evaluate further improvements for the CCM and RPM payments including those originally proposed in July 2019. To view, these proposed changes see the dedicated blog post here or more information on Chronic Care Management (CCM) payment rules for rural health clinics and federally qualified health centers, see the dedicated blog post here To download the CMS 2020 physician fee schedule
References:- https://www.getqardio.com/qardiomd-blog/cms-finalizes-2020-cpt-code-rules-remote-patient-monitoring/ , https://codingintel.com/telemedicine-and-covid-19-faq/ , https://www.medicaleconomics.com/view/remote-patient-monitoring-update-developments-opportunities-for-physicians
