Finalized guidelines were released by the Centers of Medicare & Medicaid Services with regards to remote patient monitoring services. Hospitals and health systems will now see Medicare reimbursement for more remote patient monitoring services.
According to the final rule on Chronic Care Remote Physiologic Monitoring, CMS has expanded the reimbursement plateau for RPM services delivered “incident to” general supervision, and has added a new code – 99458 – for patients receiving an additional 20 minutes of mHealth services in a given month.
The amendments follow the introduction of three CPT codes in last year’s physician fee schedule for certain and limited connected health services. This is the right step for digital health adoption, according to healthcare providers and telehealth experts.
The “incident to” revision aims to expand RPM reimbursement by letting more providers and business models to use the technology.
An “incident to” service is defined by CMS as a service performed under the supervision of a qualified healthcare professional and billed to Medicare in the name of that professional, subject to certain requirements.
Originally CMS mandated that RPM services couldn’t be delivered incident to the physician’s service. But later allowed some incident to reimbursement by certain members of the care team under direct supervision of the physician.
Direct supervision means that both physician and care team member have to be in the same building at the same time. This poses a challenge for many telehealth companies and health systems who view RPM as a means of connecting care providers in one place with patients in another location, such as the home.
Keeping this in mind, telehealth advocates requested CMS to allow RPM use under general supervision. This according to Medicare, doesn’t need both parties to be in the same building and can be accomplished through telemedicine.