{"id":26050,"date":"2019-11-05T21:49:58","date_gmt":"2019-11-05T21:49:58","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=26050"},"modified":"2019-11-05T21:49:58","modified_gmt":"2019-11-05T21:49:58","slug":"medicare-remote-patient-monitoring-cms-finalizes-new-code-and-general-supervision","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/medicare-remote-patient-monitoring-cms-finalizes-new-code-and-general-supervision\/","title":{"rendered":"Medicare Remote Patient Monitoring: CMS Finalizes New Code and General Supervision"},"content":{"rendered":"\n

05 November 2019 Authors: Nathaniel M. Lacktman<\/a>Emily H. Wein<\/a><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

CMS just released the 2020 final rule<\/a> with changes to remote patient monitoring (RPM), officially titled \u201cChronic Care Remote Physiologic Monitoring,\u201d reimbursed under the Medicare program, as part of the Physician Fee Schedule changes. The changes, proposed earlier this year<\/a>, have been hotly-anticipated by digital health companies hoping to see more clarity and flexibility for RPM services.<\/p>\n\n\n\n

CMS finalized two changes, both of which are effective January 1, 2020: <\/p>\n\n\n\n

  1. RPM can be furnished \u201cincident to\u201d under general supervision; and <\/li>
  2. CPT Code 99458 is a new add-on code for patients who receive an additional 20 minutes of RPM services in a given month (i.e., 40 minutes of RPM services). <\/li><\/ol>\n\n\n\n

    These changes come at the heels of OIG\u2019s proposal to allow providers to waive patient cost-sharing<\/a> (e.g., co-pays) for RPM services.<\/p>\n\n\n\n

    RPM Can Be Delivered \u201cIncident To\u201d Under General Supervision<\/h2>\n\n\n\n

    When CMS first created the RPM codes, they stated RPM could not be delivered \u201cincident to\u201d a physician\u2019s service, reasoning<\/a> that CPT code 99457 describes professional time and \u201ctherefore cannot be furnished by auxiliary personnel \u201cincident to\u201d a practitioner\u2019s professional services.\u201d An \u201cincident to\u201d service is one that is performed under the supervision of a physician (broadly defined to include qualified healthcare professionals), and billed to Medicare in the name of the physician, subject to certain requirements. CMS later issued a technical correction<\/a>, allowing \u201cincident to\u201d billing of RPM services by auxiliary personnel under direct supervision. However, direct supervision means the physician and auxiliary personnel must be in the same building at the same time (albeit not the same room), a requirement many RPM companies felt stifled their business model potential.  General supervision, in contrast, as defined by Medicare, does not require the physician and auxiliary personnel to be in the same building at the same time, and the physician could instead use telemedicine to exert general supervision over the auxiliary personnel.<\/p>\n\n\n\n

    Industry insiders advocated for changing the RPM rules to expressly allow \u201cincident to\u201d billing of RPM under general supervision and CMS concurred. Because care management services include establishing, implementing, revising, or monitoring treatment plans, as well as providing support services, and because RPM services include establishing, implementing, revising, and monitoring a specific treatment plan for a patient related to one or more chronic conditions that are monitored remotely, CMS will now include CPT codes 99457 and 99458 as designated care management services. As designated care management services, RPM can be furnished under general supervision. The regulation, at 42 CFR \u00a7 410.26(b)(5), states that designated care management services can be furnished under the general supervision of the \u201cphysician or other qualified health care professional (who is qualified by education, training, licensure\/regulation and facility privileging)\u201d when these services or supplies are provided \u201cincident to\u201d the services of a physician or other qualified healthcare professional.  (See also 2019 CPT Codebook, page xii.)<\/p>\n\n\n\n

    Starting January 1, 2020, RPM services reported with CPT codes 99457 and 99458 may be billed \u201cincident to\u201d under general supervision. The physician or other qualified healthcare professional supervising the auxiliary personnel need not be the same individual treating the patient more broadly. However, only the supervising physician or other qualified healthcare professional may bill Medicare for \u201cincident to\u201d services.  <\/p>\n\n\n\n

    Changing the RPM rules to allow \u201cincident to\u201d billing under general supervision greatly expands the potential operations and business models associated with RPM services, thereby allowing more patients to enjoy the quality-improving benefits of remote patient monitoring.<\/p>\n\n\n\n

    New RPM Code for Extra 20 Minutes<\/h2>\n\n\n\n

    CPT code 99457 will now cover the initial<\/em> 20 minutes of monitoring services, while the new CPT code 99458 is used as an add-on code for those patients who receive an additional <\/em>20 minutes of RPM. The new code descriptors are as follows:<\/p>\n\n\n\n