The release of the 2019 Physician Fee Schedule Rule from the Centers for Medicare and Medicaid Services (CMS) opened more doors for the use of remote patient monitoring (RPM) in hospitals and health systems still operating in a fee-for-service financial model. In the rule, CMS released three new codes that support reimbursement for remote monitoring programs, offering providers a way to deploy programs and see financial return.
In a recent survey of health system leaders, the most-cited barrier to adopting a remote care strategy was a lack of reimbursement from providers, followed closely by an unproven financial model. However, these three new codes are offering a solution to this common challenge many providers are facing today. CPT codes 99453 and 99454 reimburse for setting up technologies, patient education and transmission of data for the “remote monitoring of physiologic parameters,” and CPT code 99457 covers “20 minutes or more of clinical staff/physician/ other qualified healthcare professional time in a calendar month” reviewing and utilizing physiologic data.
These codes are a major indicator of CMS support for a shift toward value-based care and the use of programs and tools that can make patient care more effective. “However, there is still a need for broader financial support for the use of additional types of patient-generated health data, for the reimbursement of in-home medical devices, and to broaden the roles and type of healthcare professionals that can bill for the review of these data,” said Validic™ CEO Drew Schiller.
Despite these shortcomings, many health systems are recognizing the potential new reimbursements offer the support of RPM. Not only are leading organizations taking advantage, but smaller healthcare organizations with lower budgets and fewer resources are finding these opportunities incredibly valuable.
To learn more about new reimbursement opportunities and financial models supporting RPM, read the latest white paper.