Get Reimbursed Using Expy Health

Remote patient monitoring
& reimbursement codes

1
2
3
x

99453

Remote monitoring of physiologic parameters

x

99454

Device supply with daily recordings or programmed alerts transmission

x

99091

Collection and interpretation of physiologic data

CODES
Medicare Reimbursement

New Remote Patient Monitoring Codes

The Center for Connected Health Policy defines 'remote patient monitoring' (RPM) as the use of 'digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location for assessment and recommendations.'

‘This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.’

Remote monitoring of physiologic parameters, initial set-up & patient education on use of equipment

Device supply with daily recordings or programmed alerts transmission, each 30 days

Remote physiologic monitoring treatment management services, time requiring interactive communication with the patient/caregiver during the month

Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver

Reimbursement

Example of How to Bill for Remote Care

BILLING
expand regulatory waivers around telehealth and remote care

Policy changes related to COVID-19

As a result of the COVID-19 public health emergency, on March 6, 2020, the “Coronavirus Preparedness and Response Supplemental Appropriations Act” was signed into law. This would signal the first of several legislative enactments including the Families First Coronavirus Response Act (signed into law on March 18, 2020) and the Coronavirus Aid, Relief and Economic Security (CARES) Act (signed into law on March 27th, 2020). Importantly, the enactments expand regulatory waivers around telehealth and remote care to reduce burdensome requirements on providers and health systems.

Expy Surgery serves as an extension of the care team by guiding patients to the best outcome with proven protocols. Providers can now view real-time patient reported outcomes, keep patients engaged, and identify high-risk patients early on.

COVID-19
Waive patient cost-sharing payments for telehealth

The Office of the Inspector General (within the Department of Health and Human Services), is allowing physicians and other healthcare providers to waive patient cost-sharing payments for telehealth services and other non-face-to-face services like monthly remote care management and remote patient monitoring for the duration of the public health emergency.

Plans cover telehealth without cost to patient

A temporary safe harbor is allowing high-deductible health plans (HDHP) to cover telehealth services and other remote care without cost to plan members before plan members’ deductibles are met. This applies to all HDHPs, including those with plan members using HSAs.

$200 million allocated to fund telehealth

The Federal Communications Commission has implemented a $200 million program to fund telehealth services and some end user devices for healthcare providers and to cover the costs associated with some services and personnel.

Reducing burdensome requirements on providers and health systems

Policy changes related to COVID-19

These policies were a result of the efforts in response to the COVID-19 public health emergency

Remote Physiologic Monitoring CPT® / Treatment Management Services

Remote monitoring of physiologic parameter(s) (e.g. weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment

Who:

Must be ordered by physician or qualified health care professional (QHCP)**

Auxiliary personnel (including those “not clinical staff” but employees or leased or contracted employees) are allowed to furnish services under the general supervision of the billing physician or practitioner.

How Often:

Should be reported only once during a 30-day period (even when multiple medical devices are provided to a patient), can be billed by only one practitioner, only once per patient per 30-day period and only when at least 16 days of data have been collected

Medicare Rate:

$19.19 (Both non-Facility and Facility)
Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

Who:

Must be ordered by physician or QHCP**

Auxiliary personnel (including those “not clinical staff” but employees or leased or contracted employees) are allowed to furnish services under the general supervision of the billing physician or practitioner.

How Often:

Should be reported only once during a 30-day period (even when multiple medical devices are provided to a patient), can be billed by only one practitioner, only once per patient per 30-day period and only when at least 16 days of data have been collected

Medicare Rate:

$63.16 (Both non-Facility and Facility)
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

Who:

Performed by physicians and non-physician providers (NPP) who are eligible to furnish evaluation and management, or auxiliary personnel/clinical staff under the general supervision of the billing provider

How Often:

Per calendar month

Medicare Rate:

$50.94 (Non-Facility Rate)
$31.75 (Facility Rate)

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes

Who:

Performed by physicians and non-physician providers (NPP) who are eligible to furnish evaluation and management, or auxiliary personnel/clinical staff under the general supervision of the billing provider

How Often:

Per calendar month

Medicare Rate:

$41.17 (Non-Facility Rate)
$31.75 (Facility Rate)
Collection and interpretation of physiologic data (e.g. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days

Who:

Performed by physician or other QHCP, not clinical staff

How Often:

Reported each 30 days

Medicare Rate:

$56.88 (Both non-Facility and Facility)

Reimbursement can offset staff time to help support patient care

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