We’re well into the new year, and the final 2022 physician fee schedule from the Centers for Medicare & Medicaid Services (CMS) is officially in effect, with some key changes to remote patient monitoring reimbursement. What’s that mean for providers, practitioners and organizations offering remote care services to their patients — or who are looking to start doing so?
Here’s the short version: The new fee schedule has significantly expanded some aspects of remote patient monitoring reimbursement, while making slight adjustments elsewhere. For instance, although some previous allowances for remote patient monitoring (RPM) have been reduced a bit, reimbursement has increased for other services like remote therapeutic care and chronic care management.
For providers looking to extend their remote care offerings to take advantage of these new guidelines, here’s what you should know.
Remote Therapeutic Monitoring & Mental Health Reimbursement
Many of the changes to the CPT (Medicare shorthand for “current procedural terminology”) codes have been designed to extend remote patient monitoring reimbursement that went into effect as a result of Covid-19 public health emergency (PHE).
And even though that PHE has now been extended for another 90 days — or mid-April, as of this writing — these new reimbursement codes are good through 2022, with the possibility of becoming permanent as we move into 2023.
Regarding remote care (or telehealth services, in the terminology used by the CMS), the most significant changes involve the expanded reimbursement for remote therapeutic monitoring (RTM) and remote mental health care.
In general, the RTM codes are designed to cover the monitoring of health conditions such as “musculoskeletal status respiratory system status, therapy (medication) adherence, and therapy (medication) response,” as per an analysis by JD Supra. These include CPT codes 98975-98977, which include service initiation (with an allowance of $19.38) and monthly data transmissions ($55.72). They also include 98980-98981, which cover as much as $50.18 for 20 minutes of treatment management services.
Unlike RPM codes, these RTM codes are for general medicine, which means that they can be billed by providers that don’t conduct evaluation and management. This opens the door for more widespread use of RTM by practitioners and organizations that may not currently be using this technology.
Mental health that’s delivered remotely is also being adjusted to ease geographic restrictions. Previously, reimbursement required that a patient had to visit a doctor in person six months prior to eligibility. That requirement is now waived under most circumstances; instead, an in-person visit is required once every 12 months, as per Fierce Healthcare.
Chronic Care Management & Remote Patient Monitoring Reimbursement
While RTM and mental health services have expanded, reimbursement has been rolled back slightly for remote patient monitoring (RPM). Most of these cuts are minor, amounting to less than a dollar — including 99453 (service initiation, reduced by $0.15), 99091 (Interpretation and analysis, reduced by $0.47), and 99457 and 99458 (treatment management, reduced by as much as $0.76).
The biggest reduction to remote patient monitoring reimbursement has been to code 99454, covering monthly data transmission, which has been reduced by $7.44.
In making these changes to the 2022 physician fee schedule, the CMS seems to be trying to encourage providers to combine RPM with chronic care management (CCM) services. Five new CPT codes have been added to this effect (99437, 99424, 99425, 99426, and 99427), offering significant changes in reimbursement for managing patients with chronic conditions.
As chronic care management is very often the basis for the use of RPM, some providers may see an opportunity to add the new CCM codes to their existing RPM, while improving without necessarily changing the way they treat their patients.
Take CPT code 99490 for instance. Covering at least 20 minutes of physician-directed chronic care management services, reimbursement has increased from $42 in 2021 to $65.61 in 2022 — an increase of $23.61. That could be a big motivator for some providers, and it doesn’t necessarily involve a shift away from remote care.
2022 Physician Fee Schedule Changes: What’s the Takeaway?
Why are these changes to remote patient monitoring reimbursement—as well as compensation for other aspects of telehealth and CCM—so important? While some remote care services may be slightly less incentivized, the big increases for RTM and CCM mean that more money will certainly be invested in remote care over the coming year.
If you’re seeking guidance on the use of remote care technology, we encourage you to download our “Reimbursement Tree” guide, a convenient, one-page summary of all key reimbursement codes.
We’re well into the new year, and the final 2022 physician fee schedule from the Centers for Medicare & Medicaid Services (CMS) is officially in effect, with some key changes to remote patient monitoring reimbursement. What’s that mean for providers, practitioners and organizations offering remote care services to their patients — or who are looking to start doing so?
Here’s the short version: The new fee schedule has significantly expanded some aspects of remote patient monitoring reimbursement, while making slight adjustments elsewhere. For instance, although some previous allowances for remote patient monitoring (RPM) have been reduced a bit, reimbursement has increased for other services like remote therapeutic care and chronic care management.
For providers looking to extend their remote care offerings to take advantage of these new guidelines, here’s what you should know.
Remote Therapeutic Monitoring & Mental Health Reimbursement
Many of the changes to the CPT (Medicare shorthand for “current procedural terminology”) codes have been designed to extend remote patient monitoring reimbursement that went into effect as a result of Covid-19 public health emergency (PHE).
And even though that PHE has now been extended for another 90 days — or mid-April, as of this writing — these new reimbursement codes are good through 2022, with the possibility of becoming permanent as we move into 2023.
Regarding remote care (or telehealth services, in the terminology used by the CMS), the most significant changes involve the expanded reimbursement for remote therapeutic monitoring (RTM) and remote mental health care.
In general, the RTM codes are designed to cover the monitoring of health conditions such as “musculoskeletal status respiratory system status, therapy (medication) adherence, and therapy (medication) response,” as per an analysis by JD Supra. These include CPT codes 98975-98977, which include service initiation (with an allowance of $19.38) and monthly data transmissions ($55.72). They also include 98980-98981, which cover as much as $50.18 for 20 minutes of treatment management services.
Unlike RPM codes, these RTM codes are for general medicine, which means that they can be billed by providers that don’t conduct evaluation and management. This opens the door for more widespread use of RTM by practitioners and organizations that may not currently be using this technology.
Mental health that’s delivered remotely is also being adjusted to ease geographic restrictions. Previously, reimbursement required that a patient had to visit a doctor in person six months prior to eligibility. That requirement is now waived under most circumstances; instead, an in-person visit is required once every 12 months, as per Fierce Healthcare.
Chronic Care Management & Remote Patient Monitoring Reimbursement
While RTM and mental health services have expanded, reimbursement has been rolled back slightly for remote patient monitoring (RPM). Most of these cuts are minor, amounting to less than a dollar — including 99453 (service initiation, reduced by $0.15), 99091 (Interpretation and analysis, reduced by $0.47), and 99457 and 99458 (treatment management, reduced by as much as $0.76).
The biggest reduction to remote patient monitoring reimbursement has been to code 99454, covering monthly data transmission, which has been reduced by $7.44.
In making these changes to the 2022 physician fee schedule, the CMS seems to be trying to encourage providers to combine RPM with chronic care management (CCM) services. Five new CPT codes have been added to this effect (99437, 99424, 99425, 99426, and 99427), offering significant changes in reimbursement for managing patients with chronic conditions.
As chronic care management is very often the basis for the use of RPM, some providers may see an opportunity to add the new CCM codes to their existing RPM, while improving without necessarily changing the way they treat their patients.
Take CPT code 99490 for instance. Covering at least 20 minutes of physician-directed chronic care management services, reimbursement has increased from $42 in 2021 to $65.61 in 2022 — an increase of $23.61. That could be a big motivator for some providers, and it doesn’t necessarily involve a shift away from remote care.
2022 Physician Fee Schedule Changes: What’s the Takeaway?
Why are these changes to remote patient monitoring reimbursement—as well as compensation for other aspects of telehealth and CCM—so important? While some remote care services may be slightly less incentivized, the big increases for RTM and CCM mean that more money will certainly be invested in remote care over the coming year.
If you’re seeking guidance on the use of remote care technology, we encourage you to download our “Reimbursement Tree” guide, a convenient, one-page summary of all key reimbursement codes.
Questions about RPM or other types of remote care? CareSimple is standing by to help answer them. Contact us today to get in touch with one of our experts.