AMA Adds Connected Health CPT Codes, Pushes for Medicare Payment

September 07, 2018 – The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to encourage CMS to pay for the services.

The 2019 CPT code set contains 335 code changes that will go into effect for medical billing and coding on Jan. 1, 2019.

A number of those code changes are new codes that can be used to capture the use of connected health tools that support clinicians as they engage in population health and care coordination services, as well as other innovative care delivery services, the AMA explained.

Among those new CPT codes are three remote patient monitoring codes that represent how providers use health IT system to connect with their patients in their homes and collect data for care management and care coordination.

The 2019 CPT code set also includes two new interprofessional internet consultation codes. The new codes aim to show the increasing importance and prevalence of using non-verbal communication technology to coordinate care between a consulting and treating physician, the AMA stated.

The industry group hopes the creation of new connected health codes will prompt CMS to reimburse providers for delivering innovative, technologically advanced care.

“The AMA has urged the Centers for Medicare and Medicaid Service to adopt the new codes for remote patient monitoring and internet consulting and designate the related services for payment under federal health programs in 2019,” stated AMA President Barbara L. McAneny, MD.

“Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care,” she added.

CMS uses a portion of CPT codes in its own medical billing and coding set, the Healthcare Common Procedure Coding System (HCPCS). But the federal agency does not use the full CPT code set for Medicare and Medicaid reimbursement.

Other important CPT code changes for 2019 include the addition and revision of codes for skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis, and central nervous system assessments, including psychological and neuropsychological testing.

“The CPT code set is the foundation upon which every element of the medical community—doctors, hospitals, allied health professionals, laboratories and payers—can efficiently share accurate information about medical services,” said McAneny.

“The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures,” she continued.

AMA’s push to get CMS on board with remote patient monitoring, internet consulting, and other connected health services is shared by many other stakeholders. Recently, close to 50 healthcare organizations and vendors called on the federal agency to improve claims reimbursement opportunities for remote patient monitoring.

The groups specifically asked CMS Administrator Seema Verma to modify and add CPT codes to enable Medicare reimbursement for mobile health programs that collect patient-generated health data in the home.

The Healthcare Information and Management Systems Society (HIMSS) also urged CMS in 2017 to “embrace a reimbursement system that recognizes the unique characteristics of connected health that enhances the care experience for the patient, providers and caregivers.”

Getting medical billing and coding up to speed with connected health services has been a long journey. But CMS recently signaled a change in its billing and coding rules.

The proposed 2019 Medicare Physician Fee Schedule would start to reimburse clinicians for virtual care, including virtual check-ins and evaluations of patient-submitted photos. The proposal would also expand Medicare-covered telehealth services to include prolonged preventative services.

“CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner,” Administrator Verma stated.

Industry experts view the proposed 2019 Medicare Physician Fee Schedule as a major shift in Medicare and Medicaid’s acceptance of telehealth and connected health services.

“CMS’ proposed rule is a landmark change allowing providers to much more meaningfully use new technologies when delivering medical care,” Nathaniel Lacktman, a partner and healthcare lawyer with Foley & Lardner LLP, recently told mHealthIntelligence.com.

“By including new payment codes for remote patient monitoring, virtual check-ins, asynchronous image and video review and peer-to-peer consultations, the proposed rule exemplifies CMS’ renewed vision and desire to bring the Medicare program into the future of clinically-valid telemedicine services,” continued Lacktman, who also chairs the firm’s Telemedicine Industry Team and co-chairs its Digital Health Work Group.

While the proposed Medicare reimbursement rule was a significant step for CMS, providers should be looking to their policymakers for further remote patient monitoring and connect health support, he added.

“In my opinion, CMS has done everything within its authority to encourage providers to use these new technologies, and the only notable limitations remaining are statutory in nature,” he said. “This means that only Congress has the power to significantly expand Medicare coverage of telehealth services (e.g., eliminating the rural geographic or originating site limitations) and would do so by amending the Social Security Act.”

“Congress did just that earlier this year with regard to stroke and ESRD [end-stage renal disease] services,” he continued. “We may see more from Congress.”

With the backing of new CPT codes from the AMA, healthcare leaders and policymakers are sure to see how providers value connected health services to improve care quality and reduce healthcare costs.