Medicare’s Reimbursement for Telemedicine

The Centers for Medicare & Medicaid (CMS), published a Proposed Rule about significant modification to Medicare payment policies under the Physician Fee Schedule (PFS) for Part B services rendered in CY 2019, on July 27, 2018.

The Proposed Rule includes changes to the documentation requirements for Evaluation and Management services (E/M) and relative value of services (RVU) to include changes in medical practice and reduce the administrative burden on practitioners.

This proposal by CMS acknowledges the evolving use of technology in medical practice. It proposes to add an exclusive payment for brief non-face-to-face interventions with physicians by using communication technology to assess patient’s condition and determine if an office visit is required.

Its necessary to draw attention to the major changes in reimbursement for remote patient management and store and forward telehealth.

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There are three new Remote Physiologic Monitoring (RPM) codes retitled “Chronic Care Remote Physiologic Monitoring”. The codes are CPT 990X0, 990X and 994X9. These new codes differ from the old code (CPT 99091) in several substantial respects.

  • Lesser treatment time is required to qualify for reimbursement.
  • New code offers separate reimbursement for work associated with bringing a patient on board, setting up the RPM equipment and providing patient training. This will encourage providers to use these technologies.
  • CPT 99091 was meant for only physicians and qualified health professionals. But, the new code allows RPM services to be performed by clinical staff.
  • The old number requires “incident to” billing and it requires auxiliary personnel to be under direct supervision of a physician. But, under the new code, physicians don’t have to be in the premises at the same time and physician can supervise via telemedicine.

Comments to the proposed rules are due by September 10, 2018, with a final ruling expected in November. This is owing to the increasing popularity of remote patient monitoring software in the healthcare industry.