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.