AMA, industry leaders call on CMS to expand remote patient monitoring reimbursement
- In a Monday letter to CMS Administrator Seema Verma, 49 healthcare organizations and vendors urged the agency to expand reimbursement for remote patient monitoring.
- The group, which includes the American Medical Association, UPMC and Mount Sinai Health System, praised CMS’ unbundling of CPT 99091 in the 2108 Physician Fee Schedule final rule, which distinguishes between remote monitoring services and telemedicine. Among other things, the code allows doctors and qualified health professionals to bill for patient-generated health data collected and interpreted remotely from the home, work or elsewhere.
- However, the letter argues that CMS needs to follow through with promises to explore additional digital health codes.
CMS’ unbundling of CPT 99091 dovetailed with an AMA panel’s creation of three new CPT codes. The group urges CMS to embrace the new codes while continuing CPT 99091’s unbundling.
"There is an existing body of evidence demonstrating that these services will increase value and improve patient health outcomes, particularly for patients with multiple co-morbidities, chronic conditions and those facing barriers to due to geography, limited mobility, medical fragility,” the authors wrote.
The three AMA codes are:
- 990X0: Remote monitoring of physiologic parameter(s)(e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment;
- 990X1: Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days; and
- 994X: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
As telehealth and remote patient monitoring gain traction, physicians are looking to be reimbursed at rates equal to those of doctors who provide the same services on-site. In addition to improving outcomes by allowing doctors to keep tabs on patients between visit, RPM proponents argue the service can lower healthcare costs by catching issues with chronic conditions before they escalate and necessitate an emergency room visit or inpatient care.
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