CMS Makes Changes in Remote Patient Monitoring Reimbursement

As hospitals and health systems continue to develop and scale their remote patient monitoring (RPM) capabilities, the reimbursement landscape is shifting incrementally toward payment for these capabilities. Last year, CMS offered 3 new CPT codes to reimburse for specific RPM services. While this was an important step forward in allowing RPM to support chronic care patients, the changes were complex and provided only minimal impact.

Now, however, in the 2020 Proposed Physician Fee Schedule, CMS is revisiting the subject of reimbursement for RPM services and is planning to offer 2 new changes that many hope will provide more substantial, positive outcomes. First, CMS plans to modify CPT code 99457, which was introduced last year, to refer to the first 20 minutes that physicians or clinicians spend in a calendar month supporting RPM services through interactive communication with a patient or caregiver. Correspondingly, CMS plans to offer CPT code 994X0 to allow for reimbursement of the same services for an additional 20 minutes after the initial 20 minutes. It is not clear if there are limitations on how frequently this new code could be used in a given month.

Second, CMS is planning to offer “incident to” billing of CPT code 99457 under general supervision. When this code was introduced, it was only designed to cover related services delivered by a physician. However, with this change, organizations would be allowed to use both 99457 and 994X0 as long as those services are provided under general supervision. This change would allow for the creation of new operations and business models not previously possible, permit the expansion of RPM services, and support an increase in the number of patients who may benefit from these offerings.

Innovation Continues in Body Sensor Technology

As adoption of RPM services is incentivized by CMS and organizations recognize the value these capabilities can provide, developments in RPM continue to advance. Specifically, research is progressing on body sensors to monitor patient vital signs. Previously developed flexible body-worn sensors that conform to the skin were bulky, contained rigid electronic chips and batteries, and required recharging. But now, a team at Stanford University has developed BodyNet, which takes the flexible sensor design to the next level.

BodyNet sensors don’t have onboard electronic chips or any other rigid components. The sensors are powered using nearby radiofrequency devices that can be integrated into clothing. This low-profile approach provides enough electricity to activate the sensing mechanism and to transmit the readings back to the devices built into clothing.

As your organization seeks to establish a sustainable remote patient monitoring capability, consider the following recommendations for long-term success:

  • Ensure that your health system is continuously reviewing and refining your business model using patient-generated data.
  • Seek opportunities to invest in the organization’s digital infrastructure to allow for accelerated data transmissions and appropriate data storage.
  • Increase the clinical team’s abilities and awareness of the benefits of remote patient monitoring on patient outcomes and the financial impact to the system.

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