Remote Patient Monitoring is becoming a more common practice among Medicare patients who want to keep costs down while still receiving the necessary care they need. RPM billing can be beneficial for patients who are unable to come into the office or clinic due to transportation issues. It is important for providers to review the patient’s records and call if there are any changes such as an escalation in symptoms.

RPM software service that allows providers to keep track of all the patients with their assigned identification numbers. When you have a large number of patients, it is difficult to keep track of those who are compliant with the treatment plan and those who are not. This dashboard data helps make sure that those who are not compliant get noticed, so they can be brought back into compliance.

This has created a new billing code, which is a set of codes used to identify various medical services and procedures offered to medicare beneficiaries.

CPT Billing Code

Remote Patient Monitoring Enrollment 

The first step in healthcare is enrolling the patient. Ensuring that the patient has a routine physical exam, laboratory tests, and other preventative care can help decrease the likelihood of chronic illnesses and illness-related death.

RPM Consent

Consent is a process that allows both the patient and the provider to make a decision about whether or not they want healthcare services. In order to provide safe and effective care, providers should ask patients for consent before providing them with healthcare services which includes asking permission to take their blood pressure, take their temperature

Providers should also inform patients of what the risks are when providing these types of services. Written consent is important to ensure that the patient is not accidentally enrolled. We recommend that written consent be filled out when it is practical and possible. This will allow patients to keep a record of their enrollment if needed.

Consent is a legal document that includes the patient’s understanding of what will happen during treatment. It is important for the patient to understand exactly what they are giving consent for so that there is no confusion about what type of treatment they are agreeing to.

Track Your Device Using RPM Software 

The device to be given to the patient has to be linked to the RPM software and the patient must be educated on it. The patient must understand how it works, what it does, and why is important for them.

The conditions to track must be marked and the condition and device that are being tracked. For example, an RPM tracking device that is linked to an oxygen tank can track when it is empty, or whenever the oxygen level drops below a certain point. This allows for continuous usage of the device.

Medicare insurance is not only meant for the elderly and disabled, but also for people under 65 who are unable to work or have a chronic condition. Medicare insurance is often associated with high deductibles, high copays, and limited benefits. However, medical billing services can help you get the most out of your Medicare coverage by lowering deductibles and making copays more affordable.

Medicare RPM Billing Code for Data Transmission

RPM Data transmission is the process of data being transmitted from a patient to their clinician. This allows improved and more timely diagnosis, treatment, and follow-up care during medical appointments. The code comes into use in many cases where patient care requires 24/7 monitoring and care.

Data Transmission is an additional code that was added to the Part B billing code list. The beneficiary must indicate the type of remote monitoring they have done and the codes to identify the particular features. 

The CMS defines the period of data transmission to be 16 days in a month. The period begins on the first day of the month and ends on the last day of that month. Data is transmitted daily and multiple times, but the standard amount of time that it is permitted to be in use is 16 days.

It is important to get at least one measurement a day from your patient. This will provide you with the necessary data to determine their progress. It also helps prevent any setbacks which could be detrimental to their health.

To minimize transmission errors, the aTouchAway platform from mTelehealth service uses a combination of methods to ensure that the data is received in the order it was sent and not altered in transit. These include cellular encryption, digital certificates, and cryptographic hashes.

Medicare Billing Code for RPM Review and Management 

A new billing code that will allow health care providers to charge Medicare patients who are remote users or have an outpatient service authorization. This billing code addresses the lack of telehealth funding and the need for providers to be able to bill directly through Medicare.

Automated Critical Alerts – Alerts to the appropriate clinical staff if the patient measurement goes outside range. This way all patient escalations are managed and there is no medico-legal issue. 

Smart-Review of Data – Significant amount of data comes in. Instead of manually reviewing the data, an automated smart review that showcases how the data is organized in charts and descriptions will help.

Point and click review – additional information can be added through point and click. It is important that this information is created by a competent medical professional. Many software is created by technical engineers and doesn’t consider medical items. 

With these features, a practice can focus their time on talking with the patient and building relationships with the patient instead of typing in data.

The post Remote Patient Monitoring (RPM) Billing – CPT Codes 99453, 99454, 99457, and 99458 – Help Your Healthcare Organization Increase Revenue appeared first on mTelehealth.

The post Billing for Telehealth Encounters – 2022 – Including Billing for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) CPT Reimbursement Codes for 2022 (CPT Codes 99453, 99454, 99457, 99458, 99091, 98975, 98976, 98977, 98980, and 98981) appeared first on mTelehealth.

The post Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) CPT Reimbursement Codes for 2022 – CPT Codes 99453, 99454, 99457, 99458, 99091, 98975, 98976, 98977, 98980, and 98981 appeared first on mTelehealth.

The post CMS Proposes New Remote Therapeutic Monitoring Codes: What You Need to Know appeared first on mTelehealth.

The agency has released its long-awaited final document on Medicare coverage for telehealth and remote patient monitoring services in the coming year, building upon trends seen during this year’s coronavirus pandemic.

By Eric Wicklund

December 02, 2020 – Telehealth and remote patient monitoring will see significant improvements in Medicare coverage in 2021.

The long-awaited 2021 Physician Fee Schedule, unveiled on Tuesday by the Centers for Medicare & Medicaid Services, aims to build upon the momentum for telehealth adoption seen during this year’s coronavirus pandemic. With health systems and hospitals rapidly embracing connected health, the agency has been under pressure to improve access and reimbursement guidelines.

While analyses of the final rules will come in over the next few days, here’s what CMS has included in its document.

EXPANDING COVERAGE TO NEW SERVICES AND PROVIDERS

The final rule begins with roughly 60 new telehealth services that can be reimbursed under Medicare, as follows:

• Group Psychotherapy (CPT code 90853);
• Psychological and Neuropsychological Testing (CPT code 96121);
• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99334-99335);
• Home Visits, Established Patient (CPT codes 99347-99348);
• Cognitive Assessment and Care Planning Services (CPT code 99483);
• Visit Complexity Inherent to Certain Office/Outpatient Evaluation and Management (E/M) (HCPCS code G2211); and
• Prolonged Services (HCPCS code G2212).

Those services are included under Category 1, making coverage permanent. A separate group, called Category 3, reflects services that were included in emergency waivers issued during the past year to improve connected health coverage and adoption during the public health emergency created by the coronavirus pandemic. CMS has decided these services will continue to be reimbursed through the calendar year that the public health emergency concludes:

• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337);
• Home Visits, Established Patient (CPT codes 99349-99350);
• Emergency Department Visits, Levels 1-5 (CPT codes 99281-99285);
• Nursing facilities discharge day management (CPT codes 99315-99316);
• Psychological and Neuropsychological Testing (CPT codes 96130-96133; CPT codes 96136-96139);
• Therapy Services, Physical and Occupational Therapy, All levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507);
• Hospital discharge day management (CPT codes 99238-99239);
• Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476);
• Continuing Neonatal Intensive Care Services (CPT codes 99478-99480);
• Critical Care Services (CPT codes 99291-99292);
• End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, 90962); and
• Subsequent Observation and Observation Discharge Day Management (CPT codes 99217; CPT codes 99224-99226).

In addition, CMS will now cover one nursing facility visit via telehealth every 14 days, down from once every 30 days. Telehealth advocates had argued that the frequency limit should be reduced to once every three days or even eliminated altogether, but the agency noted that these patients require longer care than hospital patients, and that a lax policy on virtual visits could have a detrimental effect on in-person care.

In its final rule, CMS has expanded the list of care providers able to be reimbursed for using telehealth to include clinical social workers, clinical psychologists, physical and occupational therapists and speech language pathologists. The agency is adding two new billing codes so that these providers can bill for virtual check-ins and remote evaluation of patient-submitted video or images.

The agency is also noting that telehealth rules don’t apply if the provider and patient are in the same location, even if the provider is using telecommunications equipment to monitor a patient to, for example, avoid risk of exposure to COVID-19.

With regard to coverage for audio-only phone check-ins, CMS is creating a new code for 11-20 minutes spent on the phone to determine the necessity of in-person care. This reimbursement would be about half as much as equivalent in-person care.

REMOTE PATIENT MONITORING COVERAGE

With more healthcare providers looking to extend care into the home, CMS has been gradually expanding coverage for what it calls remote physiologic monitoring services, and the agency proposed significant changes in the initial PFS released in August. That coverage is now set in place with the 2021 PFS.

The following RPM rules are included in the final document:

• Once the public health emergency ends, a care provider must have an established patient-physician relationship for RPM services to be furnished.
• Consent to receive RPM services may be obtained at the time that RPM services are furnished.
• Auxiliary personnel (including contracted employees) may provide services described by CPT codes 99453 and 99454 incident to the billing practitioner’s services and under their supervision.
• The mHealth technology supplied to a patient in an RPM program must be defined as a medical device under Section 201(h) of the Federal Food, Drug, and Cosmetic Act and must be reliable and valid. In addition, the data coming from these platforms must be electronically (i.e., automatically) collected and transmitted rather than self-reported.
• After the PHE ends, 16 days of data must be collected and transmitted every 30 days to meet the requirements to bill CPT codes 99453 and 99454.
• Only physicians and NPPs who are eligible to furnish E/M services may bill RPM services.
• RPM services may be medically necessary for patients with acute conditions as well as patients with chronic conditions.
• Via CPT codes 99457 and 99458, an “interactive communication” takes place in real-time and includes synchronous, two-way interactions that can be enhanced with video or other kinds of data as described by HCPCS code G2012.  In addition, the 20-minutes of time required to bill for the services of CPT codes 99457 and 99458 can include time for furnishing care management services as well as for the required interactive communication.

EXPANDED TELEHEALTH COVERAGE

In addition, CMS is expanding coverage for direct supervision through interactive communications technology, under the idea that providers can use telemedicine platforms to supervise others and monitor patients without being in the same room. To that end, the agency will allow coverage for direct supervision through real-time interactive audio-visual technology until the end of the PHE or 2021, whichever comes first.

Finally, in a press release accompanying the 2021 PFS, CMS announced that it will commission a study on telehealth use during the pandemic to “explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.”

The post CMS Finalizes Telehealth, RPM Coverage in 2021 Physician Fee Schedule appeared first on mTelehealth.

The Centers for Medicare & Medicaid Services (CMS) has provided some guidance within the “Medicare and Medicaid Programs Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” interim final rule (IFR), allowing for remote patient monitoring, or RPM.

This type of patient care is very helpful for ongoing treatment during the COVID-19 pandemic, as it allows clinicians to remotely monitor temperature and pulmonary function, blood pressure, and other appropriate physiology for changes in a patient’s disease and symptom progression, using digitally connected, non-invasive devices (e.g. sensors for body temperature or thermometers, pulse-oximeters, and home blood pressure monitors).

Many COVID-19 patients can remain at home during treatment and recovery with the monitoring of their vitals, including breathing via pulse oximetry. Checking on a patient’s breathing is an important task related to treatment of the virus. The World Health Organization (WHO) indicates that the onset of severe pneumonia in adolescents or adults occurs when SpO₂ is less than or equal to 93 percent. Patients are able to monitor their SpO₂ at home via RPM, which can better monitor for that approaching target, rather than trying to decide what “difficulty breathing” entails. 

Some RPM devices are equipped with a cellular blood pressure cuff, cellular weight scale, and a wireless pulse oximeter that accurately measures blood oxygen level, pulse rate, and perfusion index. Originally created to help with chronic care patient monitoring, there are specific Current Procedure Terminology (CPT) codes for RPM.

CPT© codes for the provision of RPM include:

• CPT Code 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), plus initial set-up and patient education on use of equipment. (Initial set-up and patient education of monitoring equipment included; do not report 99453 for monitoring of less than 16 days.)
• CPT Code 99454: Device(s) supply with daily recording(s) or programmed alerts transmission, each 30 days. (Initial collection, transmission, and report/summary services to the clinician managing the patient.)
• CPT Code 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month, requiring interactive communication with the patient/caregiver during the month; first 20 minutes.
• CPT Code 99458: Each additional 20 minutes (List separately in addition to code for primary procedure.)
• CPT Code 99091: Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring), digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/ regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.

When a code has a description that includes “time,” that is a red flag, and a reminder to be sure the provider documentation has that component included in the visit note (documented). CMS does provide reimbursement for code 99453 (approx. $20), which is for the initial set-up and patient education on how to use the monitoring equipment.  Reimbursement is also provided for CPT code 99454 (approx. $64), which is for supplying the device over a 30-day period.

Note that per the April 30 IFR, CMS will allow remote physiologic monitoring services to be reported to Medicare for periods of time of fewer than 16 days, but no less than two days, during the public health emergency (PHE). For monitoring of less than 16 days, but more than two days, payment for CPT codes 99453, 99454, 99091, 99457 and 99458 is limited to patients who have a suspected or confirmed diagnosis of COVID-19.

Remember that medical necessity will be critical for coverage of RPM, although CMS has not issued any specific guidance with regard to RPM. But in general, medical necessity means assigning the correct ICD-10-CM code (diagnosis).  Also, it is important to obtain “advance patient consent:”  practitioners must obtain permission for the service from the patient and document in the patient’s record. The justification for RPM should also be documented in the medical record in order to be compliant.

Certainly, RPM will be another area for auditing and education in the upcoming weeks and months.

The post CMS Guidance for Remote Patient Monitoring (RPM) During COVID-19 (CPT Codes 99453, 99454, 99457, 99458, and 99091) appeared first on mTelehealth.

MLN Booklet

TELEHEALTH SERVICES

ICN MLN901705 March 2020

Target Audience: Medicare Fee-For-Service Providers

The Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink.

TABLE OF CONTENTS

Originating Sites………………………………………………………………………………………………………………….. 3

Distant Site Practitioners……………………………………………………………………………………………………… 4

Telehealth Services……………………………………………………………………………………………………………… 4

Telehealth Services Billing and Payment………………………………………………………………………………. 7

Telehealth Originating Sites Billing and Payment………………………………………………………………….. 8

Resources…………………………………………………………………………………………………………………………… 8

Helpful Websites………………………………………………………………………………………………………………….. 9

Regional Office Rural Health Coordinators…………………………………………………………………………… 9

CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All Rights Reserved.

Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/

HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related

components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA

does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data

contained or not contained herein.

Page 1 of 9

Telehealth Services MLN Booklet

Page 2 of 9 ICN MLN901705 March 2020

CMS Alert!

Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 Outbreak

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act

and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS)

broadened access to Medicare telehealth services, so beneficiaries can get a wider range of

services from their doctors and other clinicians without traveling to a health care facility. On

March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth

services residing across the entire country.

Before this announcement, Medicare could only pay clinicians for telehealth services, such

as routine visits in certain circumstances. For example, the beneficiary getting the services

must live in a rural area and travel to a local medical facility to get telehealth services from

a doctor in a remote location. In addition, the beneficiary generally could not get telehealth

services in their home.

Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse

practitioners, clinical psychologists, and licensed clinical social workers, can offer a

specific set of telehealth services. The specific set of services beneficiaries can get include

evaluation and management visits (common office visits), mental health counseling, and

preventive health screenings. Beneficiaries can get telehealth services in any health care

facility including a physician’s office, hospital, nursing home or rural health clinic, as well

as from their homes. This change broadens telehealth flexibility without regard to the

beneficiary’s diagnosis, because at this critical point it is important to ensure beneficiaries

follow CDC guidance including practicing social distancing to reduce the risk of COVID-19

transmission. This change will help prevent vulnerable beneficiaries from unnecessarily

entering a health care facility when clinicians can meet their needs remotely.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/factsheets/

medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/

files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Telehealth Services MLN Booklet

Learn about these Medicare telehealth services topics:

●● Originating sites

●● Distant site practitioners

●● Telehealth services

●● Telehealth services billing and payment

●● Telehealth originating sites billing and payment

●● Resources

●● Helpful websites and Regional Office Rural Health Coordinators

Medicare pays for specific (Part B) physician or practitioner services furnished through a

telecommunications system. Telehealth services substitute for an in-person encounter.

ORIGINATING SITES

An originating site is the location where a Medicare beneficiary gets physician or practitioner medical

services through a telecommunications system. The beneficiary must go to the originating site for the

services located in either:

●● A county outside a Metropolitan Statistical Area (MSA)

●● A rural Health Professional Shortage Area (HPSA) in a rural census tract

The Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureau

decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to

HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

Providers qualify as originating sites, regardless of location, if they were participating in a Federal

telemedicine demonstration project approved by (or getting funding from) the U.S. Department of

Health & Human Services as of December 31, 2000.

Beginning July 1, 2019, the

Substance Use-Disorder Prevention

that Promotes Opioid Recovery and

Treatment (SUPPORT) for Patients

and Communities Act removes

the originating site geographic

conditions and adds an individual’s

home as a permissible originating

telehealth services site for treatment

of a substance use disorder or a

co-occurring mental health disorder.

Each December 31 of the prior calendar year (CY),

an originating site’s geographic eligibility is based on

the area’s status. This eligibility continues for a full CY.

Authorized originating sites include:

●● Physician and practitioner offices

●● Hospitals

●● Critical Access Hospitals (CAHs)

●● Rural Health Clinics

●● Federally Qualified Health Centers

●● Hospital-based or CAH-based Renal Dialysis

Centers (including satellites)

●● Skilled Nursing Facilities (SNFs)

●● Community Mental Health Centers (CMHCs)

Page 3 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

●● Renal Dialysis Facilities

●● Homes of beneficiaries with End-Stage Renal Disease

(ESRD) getting home dialysis

●● Mobile Stroke Units

Note: Medicare does not apply originating site geographic

conditions to hospital-based and CAH-based

renal dialysis centers, renal dialysis facilities, and

beneficiary homes when practitioners furnish monthly

home dialysis ESRD-related medical evaluations.

Independent Renal Dialysis Facilities are not eligible

originating sites.

Beginning January 1, 2019, the

Bipartisan Budget Act of 2018

removed the originating site

geographic conditions and added

eligible originating sites to diagnose,

evaluate, or treat symptoms of an

acute stroke. Go to MLN Matters®

article, New Modifier for Expanding

the Use of Telehealth for Individuals

with Stroke to learn how to use the

new modifier for billing.

DISTANT SITE PRACTITIONERS

Distant site practitioners who can furnish and get payment for covered telehealth services (subject to

State law) are:

●● Physicians

●● Nurse practitioners (NPs)

●● Physician assistants (PAs)

●● Nurse-midwives

●● Clinical nurse specialists (CNSs)

●● Certified registered nurse anesthetists

●● Clinical psychologists (CPs) and clinical social workers (CSWs)

o CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with

medical services or medical evaluation and management services. They cannot bill or get paid

for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

●● Registered dietitians or nutrition professional

TELEHEALTH SERVICES

You must use an interactive audio and video telecommunications system that permits real-time

communication between you at the distant site, and the beneficiary at the originating site.

Transmitting medical information to a physician or practitioner who reviews it later is permitted only in

Alaska or Hawaii Federal telemedicine demonstration programs.

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 4 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services

Service HCPCS/CPT Code

Telehealth consultations, emergency department or initial inpatient G0425–G0427

Follow-up inpatient telehealth consultations furnished to

beneficiaries in hospitals or SNFs

G0406–G0408

Office or other outpatient visits 99201–99215

Subsequent hospital care services, with the limitation of 1 telehealth

visit every 3 days

99231–99233

Subsequent nursing facility care services, with the limitation of

1 telehealth visit every 30 days

99307–99310

Individual and group kidney disease education services G0420–G0421

Individual and group diabetes self-management training services,

with a minimum of 1 hour of in-person instruction furnished in the

initial year training period to ensure effective injection training

G0108–G0109

Individual and group health and behavior assessment

and intervention

96150–96154

Individual psychotherapy 90832–90838

Telehealth Pharmacologic Management G0459

Psychiatric diagnostic interview examination 90791–90792

End-Stage Renal Disease (ESRD)-related services included in the

monthly capitation payment

90951, 90952, 90954, 90955,

90957, 90958, 90960, 90961

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients younger than 2 years of age to include

monitoring for the adequacy of nutrition, assessment of growth and

development, and counseling of parents

90963

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 2–11 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90964

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 12–19 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90965

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients 20 years of age and older

90966

End-Stage Renal Disease (ESRD)-related services for dialysis

less than a full month of service, per day; for patients younger than

2 years of age

90967

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 2–11 years of age

90968

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 5 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 12–19 years of age

90969

End-Stage Renal Disease (ESRD)-related services for dialysis less than

a full month of service, per day; for patients 20 years of age and older

90970

Individual and group medical nutrition therapy G0270, 97802–97804

Neurobehavioral status examination 96116

Smoking cessation services G0436, G0437, 99406, 99407

Alcohol and/or substance (other than tobacco) abuse structured

assessment and intervention services

G0396, G0397

Annual alcohol misuse screening, 15 minutes G0442

Brief face-to-face behavioral counseling for alcohol misuse,

15 minutes

G0443

Annual depression screening, 15 minutes G0444

High-intensity behavioral counseling to prevent sexually transmitted

infection; face-to-face, individual, includes: education, skills training

and guidance on how to change sexual behavior; performed

semi-annually, 30 minutes

G0445

Annual, face-to-face intensive behavioral therapy for cardiovascular

disease, individual, 15 minutes

G0446

Face-to-face behavioral counseling for obesity, 15 minutes G0447

Transitional care management services with moderate medical

decision complexity (face-to-face visit within 14 days of discharge)

99495

Transitional care management services with high medical decision

complexity (face-to-face visit within 7 days of discharge)

99496

Advance Care Planning, 30 minutes 99497

Advance Care Planning, additional 30 minutes 99498

Psychoanalysis 90845

Family psychotherapy (without the patient present) 90846

Family psychotherapy (conjoint psychotherapy) (with patient present) 90847

Prolonged service in the office or other outpatient setting requiring

direct patient contact beyond the usual service; first hour

99354

Prolonged service in the office or other outpatient setting requiring direct

patient contact beyond the usual service; each additional 30 minutes

99355

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; first hour (list separately in

addition to code for inpatient evaluation and management service)

99356

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 6 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; each additional 30 minutes

(list separately in addition to code for prolonged service)

99357

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) first visit

G0438

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) subsequent visit

G0439

Telehealth Consultation, Critical Care, initial, physicians typically

spend 60 minutes communicating with the patient and providers

via telehealth

G0508

Telehealth Consultation, Critical Care, subsequent, physicians

typically spend 50 minutes communicating with the patient and

providers via telehealth

G0509

Counseling visit to discuss need for lung cancer screening using

low dose CT scan (LDCT) (service is for eligibility determination

and shared decision making

G0296

Interactive Complexity Psychiatry Services and Procedures 90785

Health Risk Assessment 96160, 96161

Comprehensive assessment of and care planning for patients

requiring chronic care management

G0506

Psychotherapy for crisis 90839, 90840

Prolonged preventive services G0513, G0514

A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth)

each month to examine the beneficiary’s vascular access site.

TELEHEALTH SERVICES BILLING AND PAYMENT

Submit professional telehealth service claims using the appropriate CPT or HCPCS code.

If you performed telehealth services “through an asynchronous telecommunications system”, add the

telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ).

You are certifying the asynchronous medical file was collected and transmitted to you at the distant

site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you

furnished the billed service as a professional telehealth service from a distant site. As of January 1,

2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II

must submit institutional claims using the GT modifier.

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 7 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the

appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are

located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method

II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the

Medicare PFS facility amount for the distant site service.

TELEHEALTH ORIGINATING SITES BILLING AND PAYMENT

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for

the separately billable Part B originating site facility fee.

Note: The originating site facility fee does not count toward the number of services used to determine

payment for partial hospitalization services when a CMHC serves as an originating site.

RESOURCES

Telehealth Services Resources

For More Information About… Resource

Telehealth Services CMS.gov/Medicare/Medicare-General-Information/Telehealth/

Telehealth-Codes.html

CMS.gov/Medicare/Medicare-General-Information/Telehealth

CMS.gov/Regulations-and-Guidance/Guidance/Manuals/

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CMS has released its final rule for the 2020 Physician’s Fee Schedule.

We have previously covered how one can set up a chronic care management program in 5 steps. We have also covered the available CPT codes that can be used to bill for chronic care management, which also includes remote patient monitoring. If you want a condensed version of all that, 

The great news is none of the existing CPT codes have been modified for 2020! So a provider organization or practice can use those codes to finance their CCM and RPM programs. Especially those who have not gotten into the habit of using those CPT codes, now would be the time, as they have remained the same for the next year. So this 2019 Reimbursement Guide is still applicable, which covers both Chronic Care Management (CCM) and Remote Patient Monitoring (RPM). It will allow you to better understand the nature of those two programs. But to see exactly what changes have been made, and what it means for the reimbursement amounts for 2020, see this guide. 

For a more detailed breakdown of that guide, keep on reading.

The only changes that have happened for 2020 are the inclusion of other codes to bill extra periods of time worked on a patient and making the RPM codes furnishable via general supervision. It was only possible to furnish them via direct supervision prior.

Both changes are extremely beneficial. First, they do not displace any existing codes, thus organizations and clinicians alike do not need to relearn anything. The only thing they need to do is start familiarizing themselves with the existing CPT codes(as found on the reimbursement guide), and begin using them.

Second, the new changes make it easier to implement the codes because of a more relaxed stance on supervision. They also allow more options when providing care as far as the time allotted to patient goes. We cover the changes below. Going forward in 2020, one can bookmark this page to see all CPT codes that are available to them (existing ones and new ones included). 

2020 Reimbursement Scenarios   

Before covering all reimbursement scenarios, let’s cover some definitions first. 

General Supervision: “General supervision means when the service is not personally performed by the billing practitioner, it is performed under his or her overall direction and control although his or her physical presence is not required”. 

Qualified Healthcare Professionals (QHP): “A qualified healthcare professional is an individual who is qualified by education, training, and licensure/regulation and/or facility privileges (when applicable) who performs a professional service within his or her scope of practice, and independently reports that professional service.”  

Examples of QHPs who can bill for CCM: Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse-Midwives.  

Clinical Staff: “A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service but who does not individually report that professional service.” 

Examples of clinical staff: Licensed practical nurses, medical assistants,  and registered nurses.

Looking at the language of how everything is framed, there seem to be two general options available for reimbursement strategies. 1)With Clinical Staff 2) Without Clinical Staff. Hiring clinical staff is obviously an expense that must be considered. It especially makes sense when there is a large number of patients involved.

If you Have Clinical Staff 

1st Year

*Optional Codes dependent on if the patient requires more time.

G0438 initial visit ($164)- For new first-time patients who have been enrolled with Medicare for more than one year. 

CPT 99490 ($42 for non-facility/ $32 for facility) “Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. Assumes 15 minutes of work by the billing practitioner per month.” 

*G2058 ($38 for non-facility/ $29 for facility )(reportable a maximum of two times within a given service period for a given beneficiary) – “Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.” 

CPT code 99453 ($19): “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.” 

CPT code 99454 ($64): “Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” 

CPT code 99457($52 for non-facility/ $32 for facility): “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.” 

*CPT code 99458 ($42 for non-facility/$26 for facility):  “Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.”

Minimum Annual Revenue Per Patient= $[164+(42 x 12) + 19+ (64 x 12) +(52 x 12)]= $2079

For 40 minutes of general supervision monthly.

Revenue will increase if a patient needs more time.

2nd Year

Everything remains the same except G0438 is switched with G0439, and there is no need for CPT99453 as set up is already done.

G0439 subsequent visit ($109)- For returning patients who have had the AWV before. A patient is only eligible for a subsequent visit a year after the initial visit. 

Minimum Annual Revenue Per Patient= $[109+(42 x 12) + (64 x 12) +(52 x 12)]= $2005

For 40 minutes of general supervision monthly.

Revenue will increase if a patient needs more time.

If you Don’t Have Clinical Staff 

1st Year

*Optional Codes dependent on if the patient requires more time.

G0438 initial visit ($164)- For new first-time patients who have been enrolled with Medicare for more than one year. 

CPT 99491($84 for non-facility and facility) “Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month.” 

*G2058($38)( reportable a maximum of two times within a given service period for a given beneficiary) – “Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.” 

CPT code 99091($58 for non-facility and facility): “Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.” 

*CPT code 99458 ($42):  “Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes.”

Minimum Annual Revenue Per Patient= $[164+(84 x 12) + (58 x 12)]= $1868

For 60 minutes of work monthly.

Revenue will increase if a patient needs more time.

2nd Year

Everything remains the same except G0438 is switched with G0439.

G0439 subsequent visit ($109)- For returning patients who have had the AWV before. A patient is only eligible for a subsequent visit a year after the initial visit. 

Minimum Annual Revenue Per Patient= $[109+(84 x 12) + (58 x 12)]= $1813

For 60 minutes of work monthly.

Revenue will increase if a patient needs more time.

Besides the choice of operating with or without clinical staff, there is another great fork in the road which shapes your strategy.

It is the complexity of the patient cases. Again, by the way, the language is structured in the CMS rule book, it is apparent that there is a difference between low complexity cases (non-complex CCM), and moderate to high complexity cases (complex CCM).

The complexity of the case is determined by the number of problem points and data points. 

(Taken from EM University, 2019)

 Our 2020 Reimbursement guide considers both the staffing situation and the complexity of care when coming out with different care scenarios. Download it.

Get Started!

We can help get you up and running – or customize aTouchAway for your organization.  Just get in touch!

The post The Chronic Care Management (CCM) – Remote Patient Monitoring (RPM) – Reimbursement Guide – Coverage Year 2020 appeared first on mTelehealth.

CARE MANAGEMENT SERVICES

CMS is taking steps to further refine the codes for transitional care management (TCM) and chronic care management (CCM). They have also created new codes for principal care management (PCM) services for patients that have only one serious condition.

Transitional Care Management (TCM)

CMS has finalized their proposal to allow for concurrent billing with TCM services in the following code families:

• Prolonged services without direct patient contact
• Home and outpatient international normalized ration monitoring services
• End stage renal disease services
• Interpretation of physiological data (RPM)Chronic care management
• Complex chronic care management services
• Care plan oversight services.
• See the full text for list of specific codes.

Chronic Care Management (CCM)

CMS had proposed to adopt two new G codes with new increments of clinical staff time instead of the existing single CPT code (99490), and two additional G codes to be used to establish and revise a comprehensive care plan. However, in response to commenters concerns that the temporary G codes replacing most of the CCM code set would create administrative burden, CMS has chosen to only finalize one code (G2058 – the add-on code for additional clinical staff time), because it addresses the need for a code to bill for additional time increments for non-complex CCM. G2058 could be reported a maximum of two times within a given service period for a given beneficiary.

Principal Care Management (PCM)

CMS has finalized their proposal to establish separate coding and payment for principal care management (PCM) services, which describes care management services for one serious chronic condition (as opposed to the multiple chronic conditions covered by CCM). A qualifying condition would be expected to last between 3 months and a year or until death, may have led to a recent hospitalization and/or place the patient at significant risk of death, acute exacerbation, decompensation or functional decline. The services would include coordination of medical and/or psychosocial care related to the single complex chronic condition, provided by a physician or clinical staff under the direction of a physician or other qualified health professional.

Due to the similarity between the description of the PCM and CCM services, both of which involve non-face-to-face care management services, the full CCM scope of service requirements would apply to PCM, including documenting the patient’s verbal consent in the medical record. PCM could not be billed by the same practitioner for the same patient concurrent with certain other care management services, such as CCM, behavioral health integration services and monthly capitated ESRD payments.

New Principle Care Management Codes:

HCPCS code G2064 – Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.

HCPCS code G2065 – Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.

CMS expressed concerns that this separate coding could result in a patient with multiple chronic conditions having their care managed by multiple practitioners, each only billing for PCM, which could potentially result in fragmented patient care, overlaps in services, and duplicative services. They are finalizing a requirement that ongoing communication and care coordination between all practitioners furnishing care to the beneficiary must be documented by the practitioner billing for PCM in the patient’s medical record.

CHRONIC CARE REMOTE PHYSIOLOGIC MONITORING SERVICES

One of the codes established in Sept. 2018 CPT Editorial Board for remote physiologic monitoring was 99457. Effective for CY 2020, the code has been revised, still with 99457 as the base code that describes the first 20 minutes of treatment management services, but then allows for use of an add on code, for subsequent 20 minute intervals (99458). The codes now only require that these services be delivered with general supervision of auxiliary personnel by a physician or other qualified healthcare professional, as opposed to direct supervision, as previously required. 

CMS also clarified that RPM services are not separately billable for FQHCs and RHCs because it is included in the RHC All-Inclusive Rate (AIR) or FQHC Prospective Payment System (PPS) payment.

CONSENT FOR COMMUNICATION TECHNOLOGY-BASED SERVICES

In the CY 2019 PFS, CMS finalized payment for a number of communication technology-based services, including brief virtual check in services and interprofessional consultation. Currently consent is required for each service delivered through communication technology-based services, in part to ensure that patients are aware of any fee sharing they may be responsible for. However, based on feedback CMS received that obtaining consent for each and every one of these services is burdensome, they have revised this policy for CY 2020 to only require consent once a year for technology-based services.

ONLINE DIGITAL EVALUATION SERVICE (E-VISIT)

CMS is finalizing their proposal to create new G-codes that describe the performance of an online “assessment” rather than an “evaluation” so that qualified non-physician health care professionals that fall outside the category of a practitioner able to bill for “evaluation codes”, may bill for those services.

The new codes are as follows:

G2061 – Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes.

G2062 – Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes.

G2063 – Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

These codes would be valued at a lower rate than when the service is furnished by a physician because the work is likely less, due to the acuity of the patient.

ORIGINATING SITE FACILITY FEE

For CY 2020 the payment amount for HCPCS code Q3014 (the telehealth originating site facility fee) will be 80% of the lesser of the actual charge or $26.56.

© 2019 Public Health Institute Center for Connected Health Policy

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12 August 2019 Health Care Law Today Blog Authors: Emily H. WeinNathaniel M. Lacktman

On July 29, the Centers for Medicare and Medicaid Services (CMS) issued its proposed 2020 Physician Fee Schedule rule, which contains new telehealth services covered under Medicare. Surprisingly, CMS did not receive any provider requests to add new telehealth services this year. Fortunately, CMS took it upon itself to propose three new codes. This article discusses the proposed new codes, explains how to submit public comments on the proposed rule, and describes how to submit requests for new telehealth services. The public comment period is open through September 27, 2019.

How Medicare Defines Telehealth Services

Under Medicare, the term “telehealth services” refers to a specific set of services practitioners normally furnish in-person, but for which CMS will make payment when they are instead furnished using interactive, real-time telecommunication technology. The Social Security Act governs what telehealth services are, and are not, covered under Medicare. Generally, there are five statutory conditions required for Medicare coverage of telehealth services:

1. The beneficiary (patient) is located in a qualifying rural area;
2. The beneficiary is located at one of eight types of qualifying originating sites;
3. The services are provided by one of ten categories of distant site practitioners eligible to furnish and receive Medicare payment for telehealth services;
4. The beneficiary and distant site practitioner communicate via an interactive audio and video telecommunications system that permits real-time communication between them; and
5. The Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCs) code for the service itself is named on the list of covered Medicare telehealth services.

Provided the distant site practitioner complies with each of the above requirements, the telehealth service furnished via an interactive telecommunications system will substitute for an in-person encounter, and it should meet the requirements for Medicare coverage assuming other standard coverage and payment provisions are met.

How Does CMS Assess New Telehealth Services?

There is a specific process to request additions or deletions from the list of covered telehealth services. Initially, CMS assigns each proposed code to one of two categories. Category 1 is for those services similar to professional consultations, office visits, and office psychiatry services currently on the list of telehealth services. Category 2 is for those services not similar to those on the current list of telehealth services. Proposals that fall into Category 2 undergo a more exacting review, including whether the proposed service will produce demonstrated clinical benefit for patients. When submitting a proposal to request coverage of a new service/code, it is necessary to first determine in which category the service will be considered, so that the type of clinical and nonclinical support documentation CMS expects will accompany the submission.

When Does CMS Accept Requests for New Telehealth Services?

CMS accepts requests for additions or deletions to the Medicare telehealth services list until February 10th of each calendar year. This deadline aligns with the deadline for receipt of code value recommendations from the Relative Value Scale Update Committee.

What Telehealth Services Will CMS Add for 2020?

Particularly surprising was that this year, there were no requests that CMS add new codes to the telehealth services list. It is unclear why providers failed to make such requests, but CMS speculated that the vast majority of existing services that can be appropriately delivered via telehealth are reflected by codes that are already on the list. 

Despite the absence of requests, CMS proposed adding three codes to the covered Medicare telehealth service list:

1. HCPCS code GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.
2. HCPCS code GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.
3. HCPCS code GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

These three services are sufficiently similar to services already on the list of Medicare telehealth services, so CMS classified them as Category 1. Accordingly, a streamlined review process took place. Subject to public comment, these services are expected to be added to the list of Medicare telehealth services when the final rule is published, and would go into effect January 1, 2020.

CMS also noted how the SUPPORT Act statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) for the purpose of treating the SUD or a co-occurring mental health disorder. The change also allows telehealth services for treatment of a diagnosed SUD or co-occurring mental health disorder to be furnished to individuals at any telehealth originating site (other than a renal dialysis facility), including in a patient’s home. No originating site facility fee is paid when the beneficiary’s home is the originating site. These changes became effective July 1, 2019.

How to Submit Comments on the Proposed Rule

Providers, technology companies, and entrepreneurs interested in telehealth should consider submitting comments to the proposed rule anonymously or otherwise – via electronic submission at this link. CMS is soliciting comments on the proposed rule until 5:00 p.m. on September 27, 2019. Alternatively, commenters may submit comments by mail to:

• Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1715-P, P.O. Box 8016, Baltimore, MD 21244-8016.
• Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1715-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 (for express overnight mail).  

If submitting via mail, please be sure to allow time for comments to be received before the closing date.

How to Request Additional Medicare Telehealth Services 

Interested parties need not wait on Congress or CMS to act; anyone may send CMS a request to add services (HCPCS codes) to the list of covered Medicare telehealth services. This can include medical specialty societies, individual physicians or practitioners, entrepreneurs, hospitals, state and federal agencies, telehealth companies, vendors, and even patients. Requests may be submitted at any time on an ongoing basis. The requests will be consolidated and considered during the CMS rulemaking cycle.

Each request should address the following:

• Requestor Name(s), address, and contact information.
• The HCPCS code(s) that describes the service(s) proposed for addition or deletion to the list of Medicare telehealth services. If the requestor does not know the applicable HCPCS code, the request should include a description of services furnished during the telehealth session.
• A description of the type(s) of medical professional(s) providing the telehealth service at the distant site.
• A detailed discussion of the reasons the proposed service should be added to the definition of Medicare telehealth service.
• An explanation as to why the requested service cannot be billed under the current scope of telehealth services, for example, the reason why the HCPCS codes currently on the list of Medicare telehealth services would not be appropriate for billing the service requested.
• Evidence that supports adding the service(s) to the list on either a Category 1 or Category 2 basis as explained in the section labeled “CMS Criteria for Submitted Requests.”

Email your request to Telehealth_Review_Process@cms.hhs.gov with a subject line of “Telehealth Review Process.” Alternatively, you can mail the request to: Division of Practitioner Services, Mail Stop: C4-03-06, Centers for Medicare and Medicaid Services, 7500 Security Boulevard Baltimore, Maryland 21244-1850. Attention: Telehealth Review Process.

Conclusion

Continued expansions in Medicare reimbursement mean providers should make enhancements to telehealth programs now, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of clinical quality and patient satisfaction. We will continue to monitor CMS for any rule changes or guidance that affect or improve telehealth opportunities.

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