When patients receive an explanation of benefits from their healthcare providers or insurance payers, they often see a list of services paired with a five-digit code. These codes are CPT codes. CMS recently added reimbursement codes for remote patient monitoring, allowing healthcare providers to be reimbursed for interpreting physiologic data collected by patient-facing software.
The remote patient monitoring CPT codes help standardize and communicate medical information that can be understood across the healthcare industry. This can benefit many parties, including insurance payors, physicians, medical coders, billers, and researchers (when permitted).
For example, when you receive your explanation of benefits from your health plan or hospital, the description of services provided will typically have a five-digit number in parenthesis. That number represents the CPT code for that particular service. Besides describing procedures, CPT also provides a means for reporting on clinical outcomes, such as patient safety measures and the effectiveness of interventions. The CPT code set is routinely updated and revised by the AMA’s CPT Editorial Panel to ensure that changes undergo a rigorous evidence-based review process before implementation. This is done to help maintain the integrity of the coding system and ensure that it remains accurate and up-to-date.
With the right remote patient monitoring platform, patients can connect to healthcare professionals and receive support while safely remaining home. To help make the most of this new opportunity, CMS has added reimbursement codes that incentivize RPM services.
These code pairs allow providers to receive payment for the medical device and clinical staff time required to set up and train patients on their devices. This is a valuable incentive to get providers on board with the RPM movement. RPM technologies collect physiologic data that is then digitally uploaded to a healthcare professional for interpretation. This collection and interpretation is covered by CPT 99091, which reimburses 30 minutes of clinical time per month with a physician or qualified health care provider. As CMS continues to evolve the telehealth reimbursement landscape, all healthcare providers need to understand how to leverage these new remote patient monitoring CPT codes.
Medical coders work within the CPT code set, a five-digit numeric or alphanumeric identifier that classifies a procedure and service. It’s updated by a group of experts known as the CPT Editorial Panel with insight from clinical and industry stakeholders.
In 2018, CMS recognized the benefits of remote patient monitoring and designated provisions in Medicare to support its growth by releasing CPT code 99091. This new reimbursement code enabled care organizations to get reimbursed for interpreting physiologic data collected by patients on remote monitoring devices.
However, this code must account for the initial device setup and training necessary to ensure patient engagement with their devices or the recurring monthly costs of remote monitoring software. This is why advocates asked CMS to expand the scope of this code to include more RPM-related tasks, such as reviewing a patient’s physiologic data and communicating with them in person or via telehealth services.