Due to the continuous increase in the US population and the healthcare expenses, payers have started to pay importance to the benefits of more cost-effective and qualitative healthcare. But physician office visit seems to be a considerable challenge nowadays. Remote services enabled by innovative technology can expand access to care and help patients connect with their physicians quickly.
To improve patient care through successful engagement with technology, new Current Procedural Terminology (CPT) codes would be implemented for health professionals to get paid for emerging services. On January 1, 2019, several old CPT billing codes were revalued, while others were replaced with new codes.
In the year 2019, Centers for Medicare & Medicaid Services (CMS) unbundles four existing codes (CPT 99446-99449) and creates two new codes (CPT 99451 and 99452) under Interprofessional Consultation to assist with the management of the patient’s health problem without the need for the patient’s face-to-face contact with the consulting physician.
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CPT 99451: Interprofessional phone/internet/EHR (Electronic Health Record) assessment and management service provided by a consulting physician, including a written report to the patient’s treating physician or other qualified health care professional, 5 minutes.
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CPT 99452: Interprofessional phone/internet/EHR referral service(s) provided by a treating physician or other skilled health care professional, 30 minutes.
The existing CPT codes were unbundled since they increase efficiency for patients and providers by eliminating the need for costly inconvenient specialist appointments where just an online interaction between the treating physician and the consulting specialist is enough to coordinate patient care. Reimbursement is possible since it was not previously available for the treating physician’s efforts in initiating the consult.
Similarly, CMS has unbundled the CPT code 99091 and created three new codes (CPT 99453, 99454, 99457) under Remote Patient Monitoring (RPM) services. These new codes help health professionals to connect with their patients at home using technology. Efficient and effective care management and coordination are possible by utilizing these reimbursement codes.
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CPT 99453: Remote physiological monitoring (weight, blood pressure, pulse oximetry, respiratory flow rate) initial setup and patient education on device use.
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CPT 99454: Daily recording(s) or programmed alert(s) device transmission, every 30 days.
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CPT 99457: Remote physiologic monitoring treatment management services, 20 minutes or more by clinical staff/physician/other qualified health care in a calendar month requiring interactive communication with the patient/caregiver during the month.
CPT 99091 requires at least 30 minutes per 30-day period, limited to treating physicians and specifically qualified professionals. But CPT 99457 requires only 20 minutes within the calendar month, including treating physicians, certain qualified professionals, and clinical staff (RNs, medical assistants, etc.). No reimbursement was offered for the initial setup and patient education in the case of CPT 99091. Hence the introduction of CPT code 99453 will encourage providers to start using RPM services for their patients.
As of 2019, CMS has added a new level of Chronic Care Management (CCM), namely CPT 99491, by increasing RPM's importance as a practice improvement option under the Merit-based Incentive Payment System (MIPS). CCM service would be personally provided by the physician or other qualified healthcare professional for 30 minutes.
Benefits of 2019 Medicare CPT codes
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Recent CPT codes prove to be cost-effective for physicians to manage their patients’ health conditions compared to more frequent face-to-face visits creating awareness among the patients about their health conditions.
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CPT codes can significantly enhance communication between providers and patients. Additionally, patients become more aware and engaged in their care without overburdening care teams.
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Reimbursement expansion can bridge the gap between fee-for-service and value-based care. With the help of recent CPT codes, health systems can keep more patients out of the hospital by delivering remote care services.
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Patient satisfaction rates can be enhanced by improving the relationships between patients and their caregivers.
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Revised CPT codes would ultimately improve the nation’s healthcare condition and empower the physicians, bringing everyone closer to a modern healthcare system delivering better care for Americans at a lower cost.
Future Proposition
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According to the AMA, the 2019 CPT codes and descriptors can be imported into existing claims and billing software using the downloadable CPT 2019 data file, which consists of an updated code set’s complete descriptor package for both physicians and consumers along with the CPT coding guidelines.
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Next year, there will be changes in 335 CPT codes, 212 codes will be added, 73 codes will get deleted, and 50 will get revised to reflect scientific and technological advances in medical, diagnostic, and surgical services.
Hence, the recent CPT codes would make a landmark shift to support physicians taking part in patient population health and care coordination services to improve quality medical care. Given the opportunities to improve patient outcomes while also bringing in new revenue streams, the recent 2019 Medicare CPT codes are certainly worth your while.
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