{"id":26354,"date":"2019-12-13T15:48:40","date_gmt":"2019-12-13T15:48:40","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=26354"},"modified":"2019-12-13T15:48:40","modified_gmt":"2019-12-13T15:48:40","slug":"the-chronic-care-management-ccm-remote-patient-monitoring-rpm-reimbursement-guide-coverage-year-2020","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/the-chronic-care-management-ccm-remote-patient-monitoring-rpm-reimbursement-guide-coverage-year-2020\/","title":{"rendered":"The Chronic Care Management (CCM) – Remote Patient Monitoring (RPM) – Reimbursement Guide – Coverage Year 2020"},"content":{"rendered":"\n
The-Chronic-Care-Management-CCM-Remote-Patient-Monitoring-RPM-Reimbursement-Guide-Coverage-Year-2020<\/a>Download<\/a><\/div>\n\n\n\n

[dflip id=”31070″][\/dflip]<\/p>\n\n\n\n

CMS has released its final rule\nfor the<\/strong> 2020 Physician\u2019s\nFee Schedule.<\/a> <\/p>\n\n\n\n

We have previously covered how one\ncan set up a chronic care management program in 5 steps<\/a>. We have\nalso covered the available CPT\ncodes<\/a> that can be used to bill for chronic\ncare management, which also includes remote patient monitoring. If you want\na condensed version of all that, <\/strong><\/p>\n\n\n\n

The great news is none of the\nexisting CPT codes have been modified for 2020! So a provider organization or\npractice can use those codes to finance their CCM and RPM programs. Especially\nthose who have not gotten into the habit of using those CPT codes, now would be\nthe time, as they have remained the same for the next year. So this\n2019 Reimbursement Guide<\/a> is still applicable, which\ncovers both Chronic Care Management (CCM) and Remote Patient Monitoring (RPM).\nIt will allow you to better understand the nature of those two programs. But to\nsee exactly what changes have been made, and what it means for the\nreimbursement amounts for 2020, see this guide<\/a>. <\/p>\n\n\n\n

For a more detailed breakdown\nof that guide, keep on reading.<\/strong><\/p>\n\n\n\n

The only changes that have\nhappened for 2020 are the inclusion of other codes to bill extra\nperiods of time worked on a patient and making the RPM codes\nfurnishable via general supervision. It was only possible to furnish them via\ndirect supervision prior. <\/p>\n\n\n\n

Both changes are extremely\nbeneficial. First, they do not displace any existing codes, thus organizations\nand clinicians alike do not need to relearn anything. The only thing they\nneed to do is start familiarizing themselves with the existing CPT codes(as\nfound on the reimbursement guide), and begin using them.<\/p>\n\n\n\n

Second, the new changes make it\neasier to implement the codes because of a more relaxed stance on supervision.\nThey also allow more options when providing care as far as the time allotted to\npatient goes. We cover the changes below. Going forward in 2020, one can\nbookmark this page to see all CPT codes that are available to them\n(existing ones and new ones included). <\/p>\n\n\n\n

2020\nReimbursement Scenarios   <\/p>\n\n\n\n

Before covering all\nreimbursement scenarios, let\u2019s cover some definitions first.<\/strong> <\/p>\n\n\n\n

General Supervision:<\/strong> \u201cGeneral supervision means when the service is not\npersonally performed by the billing practitioner, it is performed under his or\nher overall direction and control although his or her physical presence is not\nrequired\u201d. <\/p>\n\n\n\n

Qualified Healthcare Professionals\n(QHP): \u201c<\/strong>A qualified healthcare\nprofessional is an individual who is qualified by education, training, and\nlicensure\/regulation and\/or facility privileges (when applicable) who performs\na professional service within his or her scope of practice, and independently\nreports that professional service.\u201d  <\/p>\n\n\n\n

Examples of QHPs who can bill\nfor CCM:<\/strong> Physician Assistants, Nurse\nPractitioners, Clinical Nurse Specialists and Certified Nurse-Midwives.  <\/p>\n\n\n\n

Clinical Staff:<\/strong> \u201cA clinical staff member is a person who works under\nthe supervision of a physician or other qualified health care professional and\nwho is allowed by law, regulation and facility policy to perform or assist in\nthe performance of a specified professional service but who does not\nindividually report that professional service.\u201d <\/p>\n\n\n\n

Examples of clinical staff:<\/strong> Licensed practical nurses, medical assistants,  and\nregistered nurses.<\/p>\n\n\n\n

Looking at the language of how\neverything is framed, there seem to be two general options available for\nreimbursement strategies. 1)With Clinical Staff 2) Without Clinical Staff.\nHiring clinical staff is obviously an expense that must be considered. It\nespecially makes sense when there is a large number of patients involved.<\/strong><\/p>\n\n\n\n

If you\nHave Clinical Staff<\/strong> <\/p>\n\n\n\n

1st Year<\/strong><\/p>\n\n\n\n

*<\/strong>Optional Codes dependent on if the patient requires more\ntime.<\/p>\n\n\n\n

G0438 initial visit\n($164)- <\/strong>For new first-time patients\nwho have been enrolled with Medicare for more than one year. <\/p>\n\n\n\n

CPT 99490 ($42 for\nnon-facility\/ $32 for facility)<\/strong> \u201cChronic\ncare management services, at least 20 minutes of clinical staff time directed\nby a physician or other qualified health care professional, per calendar month.\nAssumes 15 minutes of work by the billing practitioner per month.\u201d <\/p>\n\n\n\n

*G2058 ($38 for non-facility\/\n$29 for facility )(reportable a maximum of two times within a given service\nperiod for a given beneficiary) \u2013 \u201c<\/strong>Chronic\ncare management services, each additional 20 minutes of clinical staff time\ndirected by a physician or other qualified health care professional, per\ncalendar month.\u201d <\/p>\n\n\n\n

CPT code 99453 ($19):<\/strong> \u201cRemote monitoring of physiologic parameter(s) (e.g,\nweight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up\nand patient education on use of equipment.\u201d <\/p>\n\n\n\n

CPT code 99454 ($64): <\/strong>\u201cDevice(s) supply with daily recording(s) or programmed\nalert(s) transmission, each 30 days.\u201d <\/p>\n\n\n\n

CPT code 99457($52 for\nnon-facility\/ $32 for facility)<\/strong>: \u201cRemote\nphysiologic monitoring treatment management services, 20 minutes or more of\nclinical staff\/physician\/other qualified healthcare professional time in a\ncalendar month requiring interactive communication with the patient\/caregiver\nduring the month.\u201d <\/p>\n\n\n\n

*CPT code 99458 ($42 for\nnon-facility\/$26 for facility):  \u201c<\/strong>Remote\nphysiologic monitoring treatment management services, clinical staff\/physician\/other\nqualified health care professional time in a calendar month requiring\ninteractive communication with the patient\/caregiver during the month;\nadditional 20 minutes.\u201d<\/p>\n\n\n\n

Minimum Annual Revenue Per\nPatient= $[164+(42 x 12) + 19+ (64 x 12) +(52 x 12)]= $2079<\/strong><\/p>\n\n\n\n

For 40 minutes of general\nsupervision monthly.<\/p>\n\n\n\n

Revenue will increase if a patient\nneeds more time.<\/p>\n\n\n\n

2nd Year<\/strong><\/p>\n\n\n\n

Everything remains the same except\nG0438 is switched with G0439, and there is no need for CPT99453 as set up is\nalready done.<\/p>\n\n\n\n

G0439 subsequent visit\n($109)- <\/strong>For returning patients who\nhave had the AWV before. A patient is only eligible for a subsequent visit a\nyear after the initial visit. <\/p>\n\n\n\n

Minimum Annual Revenue Per\nPatient= $[109+(42 x 12) + (64 x 12) +(52 x 12)]= $2005<\/strong><\/p>\n\n\n\n

For 40 minutes of general\nsupervision monthly.<\/p>\n\n\n\n

Revenue will increase if a patient\nneeds more time.<\/p>\n\n\n\n

If you\nDon\u2019t Have Clinical Staff<\/strong> <\/p>\n\n\n\n

1st Year<\/strong><\/p>\n\n\n\n

*<\/strong>Optional Codes dependent on if the patient requires more\ntime.<\/p>\n\n\n\n

G0438 initial visit\n($164)- <\/strong>For new first-time patients\nwho have been enrolled with Medicare for more than one year. <\/p>\n\n\n\n

CPT 99491($84 for non-facility\nand facility) \u201c<\/strong>Chronic care management\nservices, provided personally by a physician or other qualified health care\nprofessional, at least 30 minutes of physician or other qualified health care\nprofessional time, per calendar month.\u201d <\/p>\n\n\n\n

*G2058($38)( reportable a\nmaximum of two times within a given service period for a given\nbeneficiary) \u2013 \u201c<\/strong>Chronic care\nmanagement services, each additional 20 minutes of clinical staff time directed\nby a physician or other qualified health care professional, per calendar\nmonth.\u201d <\/p>\n\n\n\n

CPT code 99091($58 for non-facility\nand facility):<\/strong> \u201cCollection and\ninterpretation of physiologic data (e.g. ECG, blood pressure, glucose\nmonitoring) digitally stored and\/or transmitted by the patient and\/or caregiver\nto the physician or other qualified healthcare professional, qualified by\neducation, training, licensure\/regulation (when applicable) requiring a minimum\nof 30 minutes of time, each 30 days.\u201d <\/p>\n\n\n\n

*CPT code 99458 ($42): \n\u201c<\/strong>Remote physiologic monitoring treatment\nmanagement services, clinical staff\/physician\/other qualified health care\nprofessional time in a calendar month requiring interactive communication with\nthe patient\/caregiver during the month; additional 20 minutes.\u201d<\/p>\n\n\n\n

Minimum Annual Revenue Per\nPatient= $[164+(84 x 12) + (58 x 12)]= $1868<\/strong><\/p>\n\n\n\n

For 60 minutes of work monthly.<\/p>\n\n\n\n

Revenue will increase if a patient\nneeds more time.<\/p>\n\n\n\n

2nd Year<\/strong><\/p>\n\n\n\n

Everything remains the same except\nG0438 is switched with G0439.<\/p>\n\n\n\n

G0439 subsequent visit\n($109)- <\/strong>For returning patients who\nhave had the AWV before. A patient is only eligible for a subsequent visit a\nyear after the initial visit. <\/p>\n\n\n\n

Minimum Annual Revenue Per\nPatient= $[109+(84 x 12) + (58 x 12)]= $1813<\/strong><\/p>\n\n\n\n

For 60 minutes of work monthly.<\/p>\n\n\n\n

Revenue will increase if a patient\nneeds more time.<\/p>\n\n\n\n

Besides\nthe choice of operating with or without clinical staff, there is another great\nfork in the road which shapes your strategy.<\/strong><\/p>\n\n\n\n

It is the complexity of the\npatient cases. Again, by the way, the language is structured in the CMS rule\nbook, it is apparent that there is a difference between low complexity cases\n(non-complex CCM), and moderate to high complexity cases (complex CCM).<\/strong><\/p>\n\n\n\n

The complexity of the case is\ndetermined by the number of problem\npoints<\/a> and data points<\/a>. <\/p>\n\n\n\n

\n Overall MDM\n <\/td>\n Problem Points<\/a>\n <\/td>\n Data Points<\/a>\n <\/td>\n Risk<\/a>\n <\/td><\/tr>
\n Straightforward Complexity<\/a>\n <\/td>\n 1\n <\/td>\n 1\n <\/td>\n Minimal<\/a>\n <\/td><\/tr>
\n Low complexity<\/a>\n <\/td>\n 2\n <\/td>\n 2\n <\/td>\n Low<\/a>\n <\/td><\/tr>
\n Moderate Complexity<\/a>\n <\/td>\n 3\n <\/td>\n 3\n <\/td>\n Moderate<\/a>\n <\/td><\/tr>
\n High Complexity<\/a>\n <\/td>\n 4\n <\/td>\n 4\n <\/td>\n High<\/a>\n <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

(Taken from EM University, 2019)<\/p>\n\n\n\n

 Our 2020 Reimbursement guide\nconsiders both the staffing situation and the complexity of care when coming\nout with different care scenarios. Download it.<\/a><\/p>\n\n\n","protected":false},"excerpt":{"rendered":"

[dflip id=”31070″][\/dflip] CMS has released its final rule for the 2020 Physician\u2019s Fee Schedule. We 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