2019 CPT codes offer payment for Digital Medicine
Reflecting the reality that physicians and their staff spend an increasing amount of time engaging with technology to enhance and improve patient care, the 2019 Current Procedural Terminology (CPT®) code set that takes effect Jan. 1 provides health professionals the codes they need to get paid for emerging services.
Among the changes in the 2019 CPT code set are three new remote patient monitoring codes that reflect how health professionals can more effectively and efficiently use technology to connect with their patients at home to gather data for care management and coordination. Specifically:
99453 – Remote monitoring of physiologic parameter(s), (for example, weight, blood pressure, pulse oximetry, respiratory flow rate) initial; setup and patient education on equipment use.
99454 – Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
99457 – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
There also are two new interprofessional internet consultation codes to reflect the increasing importance of using non-verbal communication technology to coordinate patient care between a consulting physician and treating physician. Specifically:
99451 – Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
99452 – Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.
Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care.
ADDITIONAL COVERAGE REQUIREMENTS FOR THE USE OF THESE CPT CODES INCLUDE:
• Advance patient consent: practitioners must obtain advanced consent for the service and document in the patient’s record.
• 30-day reporting period: billing limited to once in a 30-day period.
• Use with other services: billing is permitted for the same service period as chronic care management (CCM) (CPT codes 99487-99490), transitional care management (TCM) (CPT codes 99495-99496), and behavioral health integration (BHI) (CPT codes 99484, 99492-99494).
• The Medicare program will be issuing additional guidance on the type of remote patient monitoring technology that will be permitted under 99454.
• CPT code 99457 and 99091 may not be billed together for same billing period and beneficiary.
Interprofessional Telephone/Internet Consultations – Uhc Guidelines
UnitedHealthcare follows CMS guidelines effective for services rendered on or after January 1, 2019, which considers interprofessional telephone/Internet assessment and management services reported with CPT codes 99446 – 99449 and 99451 – 99452 eligible for reimbursement
according to the CMS Physician Fee Schedule (PFS).
Digitally Stored Data Services/Remote Physiologic Monitoring
UnitedHealthcare follows CMS guidelines effective for services rendered on or after January 1, 2019, which considers digitally stored data services or remote physiologic monitoring services reported with CPT codes 99453, 99454, 99457 , and 99091 eligible fo r reimbursement accord ing to the CMS Physician Fee Schedule (PFS).
Modernizing Medicare Physician Payment by Recognizing Communication Technology Based Services
CMS is finalizing its proposals to pay separately for two newly defined physicians’ services furnished using communication technology:
• Brief commu nication technology -based service, for example, virtual check -in (Healthcare Common Procedure Coding System (HCPCS) code G2012)
• Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)
CMS is also finalizing policies to pay separately for new coding describing chronic care remote physiologic monitoring (Current Procedural Terminology ( CPT ) codes 99453, 99454, and MLN Matters 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448 , and 99449).
CY2019 PFS: CPT 99446, 99447, 99449, 99451, 99452
• Interprofessional internet consultation (telephone/internet/electronic health record)
– CPT 99451 – Assessment and management service provided by a consultative physician (WRVU 0.70)
• 5 or more minutes of medical consultative time
CPT 99452 – Referral service(s) provided by a treating/requesting physician or qualified health care professional (WRVU 0.70)
• 30 minutes
• Includes a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional
• Billing limited to practitioners that can independently bill Medicare for E/M services