Insights

Medicare Now Reimburses for Remote Patient Monitoring

Krista Drobac
February 14, 2018

Are you increas­ing your use of dig­i­tal ther­a­peu­tics and remote patient mon­i­tor­ing in your prac­tice? As of 2018, Medicare is cov­er­ing remote patient mon­i­tor­ing and it’s use can con­tribute to meet­ing the objec­tives of the Medicare Qual­i­ty Pay­ment Pro­gram. Learn key details of this new Medicare cov­er­age and how to inte­grate it into your prac­tice.

Medicare’s New Telehealth Code

While Medicare fee-for-ser­vice has pre­vi­ous­ly been slow to cov­er ser­vices out­side of the provider’s office, the pro­gram has just tak­en a leap for­ward by widen­ing the oppor­tu­ni­ties for physi­cians and oth­er qual­i­fied providers to use remote patient mon­i­tor­ing. The Medicare Part B CPT code, 99091, has exist­ed for a while, but pay­ment has been blocked by its sta­tus as a “bun­dled code,” mean­ing it couldn’t be paid for sep­a­rate­ly. As of Jan­u­ary of 2018, the code has been unbun­dled and can now be paid for sep­a­rate­ly.

Define Remote Patient Monitoring

This code can be used to cov­er the “col­lec­tion and inter­pre­ta­tion of phys­i­o­log­ic data.” It’s ide­al for help­ing providers man­age chron­ic health con­di­tions, such as dia­betes, by cov­er­ing the time it takes to review bio­met­ric data sent by a patient or the patient’s care­giv­er. For exam­ple, in the past, review­ing glu­cose lev­els for a per­son with dia­betes or weight gain data from a per­son with con­ges­tive heart fail­ure required them to come in for a phys­i­cal vis­it. Uti­liz­ing this ben­e­fit offers providers and patients the option to use sig­nif­i­cant­ly more con­ve­nient dig­i­tal health and remote mon­i­tor­ing tools.

Time Allocation, Payment and Providers

Under the unbun­dled 99091 code, qual­i­fied providers can be paid approx­i­mate­ly $58.00 for a cumu­la­tive time of 30 min­utes to review bio­met­ric data that is dig­i­tal­ly trans­mit­ted by the patient/caregiver. This also includes the time it takes to com­mu­ni­cate the find­ings and care plan rec­om­men­da­tions to the patient and/or care­giv­er. The providers who can bill are qual­i­fied health care pro­fes­sion­als: physi­cians and nurse prac­ti­tion­ers, physi­cian assis­tants and clin­i­cal nurse spe­cial­ists who are enrolled in Medicare Part B and super­vised by a physi­cian.

Know the Details

CMS has pub­lished the fol­low­ing require­ments for the CPT code 99091:

  • Doc­u­men­ta­tion of advance ben­e­fi­cia­ry con­sent in the patient’s med­ical record.
  • Patient exam­i­na­tion by the provider with­in one year. The provider must ini­ti­ate this ser­vice with­in a face-to-face vis­it, such as an annu­al well­ness vis­it or phys­i­cal.
  • Lim­i­ta­tion of billing of no more than once in a 30-day peri­od per patient. How­ev­er, CMS is allow­ing this ser­vice to be billed once per patient dur­ing the same ser­vice peri­od as oth­er tele­health ser­vices includ­ing: Chron­ic Care Man­age­ment (CCM) ben­e­fit (CPT codes 99487, 99489, and 99490), Tran­si­tion­al Care Man­age­ment (TCM) (CPT codes 99495 and 99496), and Behav­ioral Health Inte­gra­tion (BHI) ser­vices (CPT codes 99492, 99493, 99494, and 99484).

A Medicare Merit-based Incentive Payment System (MIPS) Improvement Activity

The new pay­ment stream for remote patient mon­i­tor­ing (CPT code 99091) is not the only new devel­op­ment to prompt greater use of remote patient mon­i­tor­ing in Medicare. The met­rics embed­ded in the new Medicare Mer­it-based Incen­tive Pay­ment Sys­tem (MIPS) also incen­tivize remote patient care. MIPS con­tin­ues the tran­si­tion from fee-for-ser­vice to val­ue-based pay­ment. As part of that, providers are mea­sured on qual­i­ty, advanc­ing care infor­ma­tion, cost and clin­i­cal improve­ment activ­i­ties, all of which lend them­selves to remote patient mon­i­tor­ing.

Specif­i­cal­ly, one of the 93 MIPS Improve­ment Activ­i­ties is the use of dig­i­tal tools to mon­i­tor patients out­side of the hos­pi­tal under the umbrel­la of “Engage Patients and Fam­i­lies to Guide Improve­ment in the Sys­tem of Care.” This includes remote mon­i­tor­ing and review and inter­pre­ta­tion of patient-gen­er­at­ed health data (PGHD). Details of this Improve­ment Activ­i­ty stip­u­late that the provider must use clin­i­cal­ly-endorsed tools that include an active feed­back loop that in turn pro­vides action­able infor­ma­tion to the patient or their care providers.

Remote Glucose Monitoring with BlueStar

A mobile med­ical app for the man­age­ment of type 2 dia­betes, like WellDoc’s BlueS­tar, is a great exam­ple of how qual­i­fied providers can put this new CPT code 99091 into prac­tice to help peo­ple with dia­betes improve their glycemic con­trol and have their time cov­ered by Medicare. View the Insights info­graph­ic on using this CPT code to man­age patients with dia­betes. It will not only lead to bet­ter mon­i­tor­ing of impor­tant bio­met­ric fac­tors, but also more fre­quent inter­ac­tions between the patient and the provider, paving the way for more rapid treat­ment opti­miza­tion.

In con­clu­sion, it’s very encour­ag­ing to see Medicare increas­ing­ly rec­og­nize, through the addi­tion of new tele­health codes the use of  dig­i­tal ther­a­peu­tics. Patients and care providers no longer need to be in the same phys­i­cal space for effi­cient and effec­tive man­age­ment.