The telemedicine industry and chronic care management just got a boost from Medicare: the unbundling of CPT 99091. Historically grouped with other charges for billing, the Medicare 2018 Physician Fee Schedule allows separate reimbursement for this code, which includes remote patient monitoring.
CPT 99091 covers the collection and interpretation of physiologic data such as blood pressure or glucose monitoring. This data must be digitally stored and/or transmitted by the patient or caregiver to a physician or other qualified health care professional meeting qualification requirements. Physicians can now receive $60 per month per patient for providing these services when the following criteria are met: 1) the patient must be informed in writing, and the consent be documented in the patient’s record; (2) a face-to-face service must be provided to the patient within the previous year, at which time the remote monitoring is initiated; and (3) the service can only be billed once in a 30-day period.
This development is good news for providers trying to balance revenue streams and time spent on chronic care. Now reimbursement goes beyond basic appointment monitoring and clinic portal access, encouraging more active use of technology to care for patients outside of clinic visits. It also opens the door for greater investment in technological innovation and better solutions. Additionally, it comes at a time when Bluetooth-enabled devices are becoming more affordable and acceptance and adoption of remote technologies for health care are increasing.
Yet, while these events are promising, the industry is wise to proceed with caution. Remote patient monitoring alone does not improve quality outcomes. If industry stakeholders are not strategic in their approach to realizing the potential of CPT 99091, it will become just an added charge to unsustainable health care costs without benefiting patients. As such, regulatory oversight is a critical part of the equation to protect patients and reward innovation that actually moves the needle on outcomes and costs.
The Opportunity Remote patient monitoring is a critical component to coordinated care, and technology increasingly makes ongoing provider-patient collaboration for chronic care management easy. For instance, Bluetooth enabled devices such as pedometers, glucometers, scales, and blood pressure cuffs have become increasingly mainstream strategies for monitoring objective information.