The Medicare program offers separate reimbursement for RPM (Remote Patient Monitoring) services billed under CPT code 99091 (effective January 1, 2018). Providers can get reimbursement of ~$59 per patient per month for RPM services billed under CPT code 99091.
This means healthcare providers have great opportunities to gain quick wins by remotely managing certain chronic conditions of their patients.
That service is defined as collection, review and interpretation of physiologic data (e.g., blood pressure, blood glucose monitoring, ECG) that is digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional.
The un-bundled CPT code 99091 means that healthcare providers will be able to get reimbursement separately for the time they spent on the above service. Any provider who clocks in a minimum of 30 minutes per month per patient for the above service is qualified to receive the payment under CPT 99091.
What Providers Should Know
- The provider must obtain advanced beneficiary consent for RPM services and document it in the patient’s medical record.
- The provider must hold a face-to-face visit with patients who are new or patients not seen by the provider within one year prior to billing RPM (such as an Annual Wellness Visit or Initial Preventive Physical Exam, or other face-to-face visit with the billing provider).
- E/M services levels 2 through 5 (CPT codes 99212 through 99215) should qualify for this face-to-face visit.
Other Requirements for CPT Code 99091
- Remote vitals monitoring with integrations with trackers and wearable devices
- The service must include collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional.
- Modification of care plan as necessary (including communication with patient and/or caregiver), and the associated documentation.
- Direct messaging for effective information exchange between patients, caregivers & family members
- Minimum non-face to face patient interaction time of 30 minutes per RPM service period
- Dynamic Care Plan shared with patient’s providers
- 24/7 access to care team
- Monthly reports required by Medicare
The providers could use RPM service code with other care/monitoring services/codes. CPT code 99091 can be billed once per patient during the same service period as Chronic Care Management (CPT codes 99487, 99489, and 99490), Transitional Care Management (CPT codes 99495 and 99496), and Behavioral Health Integration (BHI) (CPT codes 99492, 99493, 99494, and 99484).
MyCooey Solution Snapshot
MyCooey has devised a tailor-made solution to address the challenges in RPM service settings.
Some of the salient features of the solution include:
- Secure transmission of physiological data (PGHD) from IoT device to the Patient App (MyCooey platform has been integrated with iHealth, Omron, and A&D self-monitoring medical devices).
- Real-time syncing of PGHD with clinician/provider app for review, interpretation and response.
- Allows communication (video/voice/text) between patient, physician/care team and/or family members.
- Cloud based platform that works on mobiles, tabs & PCs
- Sharing of personalized health education content with patient through a smart recommendation engine.