Four questions (and answers) about the new remote patient monitoring CPT code
By Emma White on Mar 28, 2018
Patient-generated health data and remote patient monitoring are making strides in the Medicare reimbursement space this year. New CPT codes are helping accelerate the adoption of digital health tools in patient care settings to improve overall treatment and care plans. However, there’s a lot to keep up with. That’s why we read up on one of the newer CPT codes, specifically 99091 and answered some common questions that will (hopefully) have you walking away as a remote patient monitoring reimbursement expert.
QUESTION 1: Back up – what is patient-generated health data and remote patient monitoring?
Patient-generated health data (PGHD) is health data that's created, recorded, or gathered by or from patients to help address health concerns, chronic diseases, and care or treatment plans. Remote patient monitoring enables patients to be monitored outside of conventional hospital or care practice settings. While both concepts aren't exactly new, they are being pushed to new areas of innovation with the rise of digital technology as well as connectivity in the health and care management space.
QUESTION 2: Why is this PGHD important?
PGHD is becoming increasingly important in terms of gathering clinical data because of the comprehensive view it can provide of a patient’s health, especially between doctor’s visits. By gathering information on an ongoing basis and allowing patients to share health readings and updates outside of the traditional office visit, clinicians have the opportunity to improve accuracy (while avoiding readings skewed by White Coat Syndrome).
QUESTION 3: What’s CPT code 99091?
In the beginning of 2018, CMS issued 3 new codes to improve reimbursement for remote patient monitoring. CPT code 99091 specifically increases the amount physicians and care providers can be reimbursed for remote patient care. While some confuse it with CPT code 99490, 99091 does not only apply to patients suffering from chronic diseases, but those under specific care plans that include patient generated and remotely collected health data. That means remote care services that fall under CPT code 99091 can now be billed once per patient during the same 30-day service period.
QUESTION 4: What does this mean for the future of remote patient monitoring?
It is estimated that by 2020, over 57% of the US population will be living with at least one chronic disease. With nearly 86% of healthcare expenditure already being spent on chronic conditions, how can we make sure that patients are continuing to effectively monitor and manage their health after they leave their doctor's office?
The age of PGHD and remote patient monitoring are pointing in the direction of value based care. Since the release of 99091, industry response has been overall supportive of CMS' clear action in recognizing the importance and vast opportunity RPM services present. The overall positive response may come from the fact that physicians only need to spend 30 minutes a month reviewing and analyzing a patient's remotely collected data in order to get reimbursed. Though 30 minutes may seem arbitrary, spending just a minute or two per day reviewing PGHD, especially data that's been collected digitally, is time well-spent and now it's time that's properly paid for.
While in the past, remote patient monitoring was really focused on telephonic coaching or in-person visits from nurses or case managers, digital health and technology companies have quickly taken over the space. today's remote patient monitoring programs have moved from just a pure technology play to a true healthcare program and chronic care management solution. Through the use of connected devices, physicians can not only automatically see patient data as soon as a measurement is taken (BP readings, sleep patterns, heart rate, etc.), but now patients have access to their own trends too, encouraging them to take control of their own health.
Personalized platforms and portals paired with sleek connected devices are keeping both patients engaged, leaving physicians confident that care plans will be followed and closely monitored outside of the actual office visit, all while reimbursing care providers for their extra time spent analyzing PGHD.