Reimbursement Update for Remote Patient Monitoring and Chronic Care Management – CPT Codes 99091, 99490, 99487, 99489, and G0506

The 2018 Physician Fee Schedule Rule Includes Reimbursement for Remote Patient Monitoring and New Telemedicine Codes
Medicare will pay for CPT code 99091 and the 2018 unadjusted reimbursement rate will be $58.67/month.
The un-bundled CPT code 99091 in 2018 means that providers will be able to get reimbursed separately for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider, at a minimum of 30 minutes of time.
Key guidelines on the use of this code include:
• Providers must obtain advance beneficiary consent for the service and document this consent in the patient’s medical record.
• For new patients or those not seen within one year before the provision of remote monitoring services, providers must initiate these services in a face-to-face visit, such as an annual wellness visit or physical.
• Providers can use 99091 no more than once in a 30-day period per patient.
• The code includes time spent accessing the data, reviewing or interpreting the data, and any necessary modifications to the care plan that result, including communication with the patient and/or her caregiver and any associated documentation.
• This code will not be subject to any of the restrictions on originating sites or technology that telehealth services are subject to by statute, allowing users of this technology more flexibility.
Last year, CMS created a process for adding new telehealth services, based on proposals received by stakeholders. Under this new process, CMS has included several new services for 2018 that will be reimbursed when performed using telehealth technology. These new services are:
• Counseling visit for lung cancer screening (HCPCS code G0296)
• Psychotherapy for crisis (CPT codes 90839 and 90840)
• Interactive complexity (CPT code 90785)
• Patient-focused and caregiver-focused health risk assessment (CPT codes 96160 and 96161)
• Chronic care management services including assessment and care planning (HCPCS code G0506)
Each of these new services is subject to existing statutory conditions for telehealth, including requirements for use of interactive telecommunications systems and originating site restrictions.