Population Health Insights

2019 CMS Fee Schedule Expands Reimbursement for Remote Care

2019-cms-fee-schedule-expands-reimbursement-for-remote-care

It’s official: The Centers for Medicare & Medicaid Services (CMS) 2019 fee schedule is in effect as of January 1, 2019, bringing with it three new CPT codes that allow for expanded reimbursement for remote care services.

Closely watched by telehealth providers and medical device manufacturers for the potential to improve efficiencies and patient access to care, the new CPT codes relating to remote patient management (RPM) in the final 2019 Physician Fee Schedule and Quality Payment Program are as follows:

  • CMS Code 99453 covers reimbursement for initial set-up and patient education on the use of equipment for the remote monitoring of physiologic factors like weight, blood pressure, pulse oximetry, and respiratory flow rate.
  • CMS Code 99454 covers reimbursement for initial supply and daily recording or programmed alert transmission for a 30-day period for remote devices measuring the same physiologic factors as code 99453.
  • CMS Code 99457 covers reimbursement for remote monitoring and management of physiologic conditions, including 20 minutes or more per month of staff time requiring interactive communication with the patient or caregiver.

The new codes specifically “separate RPM services from telehealth, which is more restricted,” notes Eric Wicklund in an earlier preview of the 2019 CMS fee schedule from Xtelligent Healthcare Media. He adds that they also “mark an important step in the government's acceptance of mHealth and telehealth technology.”

2019 CMS Fee Schedule Changes: Potential Is High; Awareness Is Low

For the most part, industry observers agree with Wicklund’s assessment, presenting the new CPT codes as a means for RPM to become a more lucrative method of care delivery for providers. With the new codes, “RPM will become an area of significant upside potential over the coming years,” writes Nathaniel Lacktman, a healthcare lawyer specializing in telemedicine and telehealth.

“Hospitals and providers using RPM and non-face-to-face technologies to develop patient population health and care coordination services should take a serious look at these new codes, and keep abreast of developments that can drive recurring revenue and improve the patient care experience,” Lacktman advises.  

For its part, the CMS has pitched the updates to its fee schedule both as an opportunity to enhance patient access to care and a means to inspire technological innovation in healthcare delivery.

“This provides opportunities for patients around communicating with providers remotely,” said CMS Administrator Seema Verma, per Wicklund’s analysis. “This is an historic change in terms of increasing access and it’s also a great example of some of the efforts that we’re trying to make around supporting innovation.”

Yet even so, recent reports have shown that the majority of healthcare providers aren’t yet aware that the 2019 CMS fee schedule adjustments allow for expanded reimbursement for remote care services. A December 2018 telemedicine report from Reaction Data found that just 33% of physicians, administrators, healthcare executives, and IT professionals were aware of the new codes.

Leading Healthcare Providers ‘Will Be Well Prepared for this Service Addition’

But experts are also confident that this awareness will grow in the years to come, as will the use of remote care services in general. Though there remain challenges to implementation — such as the relatively slow pace of the CMS to provide widespread reimbursement — those obstacles are being steadily chipped away each year.  

“The challenges that you’re going to face are the challenges that everyone else is facing,” explains Michigan Medicine’s Dr. Chad Ellimoottil in a rundown of how providers can better implement telehealth services. “If you believe, like I do, that telehealth will be fully integrated into standard clinical care in the next 5-10 years, it’s a worthwhile endeavor to be involved in.”

Care Innovations® COO Marcus Grindstaff agrees with the inevitability of widespread RPM implementation. In his assessment of the 2019 CMS fee schedule changes, Marcus points to “a large body of evidence that well-run RPM programs reduce emergency room and hospital utilization.”

With this expanded reimbursement, “health systems can keep more patients out of the hospital by delivering remote monitoring programs to a much larger population,” Marcus notes in an earlier blog post. “This has already started … and will accelerate into 2019. The leading remote care delivery organizations will be well prepared for this service addition.

Analysis: CMS' 2019 Codes for Remote Care are 'SPOT ON'

Learn more about how the 2019 CMS fee schedule changes could help you move forward with RPM delivery: Contact us here to schedule a complimentary consultation with a Care Innovations remote care specialist.

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