Every year, the Centers for Medicare and Medicaid Services (CMS) releases Current Procedural Terminology (CPT) codes, which provide new opportunities for providers to get reimbursed successfully for their services without facing any revenue loss. According to the American Medical Association (AMA), the goal of these CPT codes is to “expand reporting pathways for physicians across the country who take care of a diverse set of patients that have varying degrees of access to care.”
The CMS released the Final Medicare Physician Fee Schedule for CY 2020 on November 1, 2019. There are 394 code revisions to the full list, including 248 new codes, 75 revisions, and 71 deletions.
Since technology keeps changing the healthcare sector, these codes also reflect them. For instance, as providers utilized technologies like remote patient monitoring and electronic visits, varied reimbursement codes were brought into action. In this article, we will discuss the new codes focused on digital health assessments for the patients.
Remote Physiologic Monitoring Treatment Management Services
CPT 99458
Under the remote patient monitoring section, a new code 99458 was created as an add-on to 99457. CPT 99457 covers the first 20 minutes of interactive communication between the patient and the provider in a calendar month. The add-on code 99458 is used to report additional 20 minutes of the same service in the same calendar month. If you want to use the CPT code 99458, it should be reported with 99457.
Digitally Stored Data Services/Remote Physiologic Monitoring
Both CPT codes 99473 and 99474 were introduced to report self-measured blood pressure monitoring.
CPT 99473
Self-measured blood pressure using a device validated for clinical accuracy, patient education/training, and device calibration.
CPT 99474
Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with the report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient.
Qualified Physician Health Care Professional - Online Digital Evaluation and Management Services
In the year 2020 CPT® book, CMS removed CPT code 99444, which is meant to be an online E/M service by a physician or other qualified healthcare professional. This code was replaced with the listed patient-initiated digital communication codes provided by a physician or other qualified healthcare professional.
CPT 99421
Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 5-10 minutes.
CPT 99422
Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 11-20 minutes.
CPT 99423
Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 21 or more minutes.
Qualified Nonphysician Health Care Professional - Online Digital Evaluation and Management Service
CPT 98970
Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 5-10 minutes
CPT 98971
Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 11-20 minutes
CPT 98972
Qualified nonphysician health care professional online evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days; 21 or more minutes
Requirements:
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The patient must initiate these services through the HIPAA compliant platform, which requires evaluation and not just providing test results
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CMS requires verbal consent.
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It cannot be billed during a post-operative period.
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It cannot be billed if the patient had an E/M service within the last seven days.
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It can be billed if the inquiry is about a new problem (different from the problem addressed at the E/M service in the past 7 days).
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Clinical staff time may not be included
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Don’t double count time with other services, such as care management, remote monitoring, etc.
Patrice A. Harris, MD, MA, the President of AMA, announced in a press release, “With the advance of new technologies for e-visits and health monitoring, many patients realize the best access point for physician care is once again their home. The new CPT codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”
Interested in implementing the technologies for health monitoring and e-visits? Contact us!
References
https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/
https://www.nixonlawgroup.com/nlg-blog/2019/11/4/how-to-get-paid-for-patient-e-visits