On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the 2020 Medicare Physician Fee Schedule Final Rule, which provides an update on payment policies, rates, and other provisions for services on or after January 1, 2020.
Regarding chronic care remote physiologic monitoring (RPM) services, the 2020 Physician Fee Schedule increases reimbursement and decreases supervision requirements. According to the 2020 Physician Fee Schedule, RPM services “involve the collection, analysis, and interpretation of digitally collected physiologic data, followed by the development of a treatment plan, and the managing of a patient under the treatment plan.”1 Therefore, in order to report code 99457, clinical staff, physicians, or other qualified professionals must provide these services for at least 20 minutes in a calendar month and have interactive communication with the patient.
RPM services might be provided to a heart failure patient who is using a wearable cardioverter defibrillator (WCD). Data captured by the WCD and posted to an online patient management system can be used to monitor the patient’s health status and response to therapy during the first few months following a cardiac event. RPM services could also be facilitated with physician-provided equipment (separately billable with code 99454).
In addition, a new RPM code was introduced in the 2020 Physician Fee Schedule. Code 99458 is used to report an additional 20 minutes of RPM after the initial 20 minutes. This code would be reported in addition to 99457 if a total of 40 minutes was spent providing the services described by the codes in a calendar month. At .61 work relative value units (RVUs), the additional 20-minute code is valued the same as the initial 20-minute code.
The 2020 Physician Fee Schedule also reduced the physician supervision requirement for RPM services from “direct” to “general.” Now, clinical staff can provide RPM services when there is no physician in the office.
The changes in the 2020 Physician Fee Schedule make RPM more attractive than ever. Now, payment is not limited to the first 20 minutes of time spent providing the service, and a physician is no longer required to be in the office when the services are rendered.
Jim Collins, CPC, CCC is the president of CardiologyCoder.Com, Inc.
Click here for additional information on coding for WCD patient follow-up and management.
- Medicare Program; CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Establishment of an Ambulance Data Collection System; Updates to the Quality Payment Program; Medicare Enrollment of Opioid Treatment Programs and Enhancements to Provider Enrollment Regulations Concerning Improper Prescribing and Patient Harm; and Amendments to Physician Self-Referral Law Advisory Opinion Regulations Final Rule; and Coding and Payment for Evaluation and Management, Observation and Provision of Self-Administered Esketamine Interim Final Rule. Federal Register. Published November 15, 2019. Available at https://bit.ly/2DTyRt1. Accessed December 6, 2019.