Proposed Medicare Changes to Expand Reimbursement for Connected Care

Aug 03, 2018

July has been a watershed month for connected care with Medicare proposing to expand coverage and reimbursement for evidence-based connected care (remote monitoring and connected visits).  Proposed changes for the 2019 Medicare Physician Fee Schedule and Medicare Home Health reimbursement policy focused heavily on connected care.  The following provides a summary:

Medicare Physician Fee Schedule Proposed Updates for 2019 [see table for new codes and estimated reimbursement levels]:

  • Remote Monitoring is proposed to be a paid service with the addition of three new CPT codes for remote patient monitoring of those with chronic conditions (one of which CMS proposes is an indirect cost and adjusted to be paid at $0 – clearly misunderstood) and a new CPT code on pulmonary wireless sensors which is described as remote monitoring
  • Brief virtual visits (internet, phone, or other communication) will be covered for established patients
  • Review of patient digitally delivered information (e.g., pictures or other information) will be covered for established patients
  • Covers some end-stage renal disease (ESRD) and stroke services when delivered by telehealth as required by law (codes already exist for these services)
  • Reimburses for INTRAPROFESSIONAL internet, or other information communication technology-enabled consultations
  • Affirms CMS policy that remote patient monitoring is NOT Medicare telehealth (which allows for it to be covered when evidence supports creation of a CPT code)

Medicare Home Health Prospective Payment System Proposed Updates:

  • The Home Health base rate can include costs of remote patient monitoring (RPM) starting in 2020 - Medicare proposes to permit RPM and RPM system costs be included as an administrative cost in the home health agencies annual cost report, to be submitted in 2019.  The 2019 reported costs, including RPM costs, would then be included in the base rate paid to home health agencies to care for a Medicare homebound beneficiary in 2020.
  • The new home infusion benefit, enacted in the Cures legislation, will require use of RPM for infusion of certain drugs.

Proposed  CY 2019 Medicare Physician Fee Schedule:  Connected Care Services/Codes to be Reimbursed

Code

Description

RVUs/Est. Reimbursement [1]

Comments

99091

Collection and Interp of Physiological Data – 30 minutes or more

1.66 RVUs |  $59

(Non Facility)

Payment began in 2018

990X0

Initial Set Up and Patient Education for Rem monitor physiological param

0.58 RVUs  |  $20

(Non-Facility)

Patients with 2+ chronic conditions

990X1

Device Supply with daily recordings for Rem monitor physiological param - monthly

1.92 RVUs  |  $69

(Non-Facility)

CMS proposes this is an indirect cost and proposes to adjust this to 0

994X9

20 min. + clinical staff time for interactive communication for Rem monitor physiological param - monthly

1.49 RVUs |  $53

(Non-Facility)

Patients with 2+ chronic conditions

93XX1

Remote Monitoring of wrls pulm-artery sensor - monthly

1.45 RVUs | $52

(Non-Facility)

In conjunction with implantation of wireless monitor

GVCI1)

Brief Virtual Check In, patient must initiate

  • 5 mins and no f2f visit prev 7 days or 24 hrs post

0.42 RVUs  |  $15

(Non Facility)

Established Patients Only

GRAS1

Rvw Remote Pt Info, patient must initiate

  • No f2f visit prev 7 days for same issue

0.36 RVUs  |  $12

(Non Facility)

Established Patients Only

994X0

Intraprof ICT Consult 30 min – FACILITY BASED ONLY

0.74 RVUs | $26

(Facility ONLY)

Patient Consent Required

994X6

Intraprof ICT Consult with written rept – FACILITY BASED ONLY

0.74 RVUs | $26

(Facility ONLY)

Patient Consent Required

99446

Interprof phone/online 5-10 – FACILITY BASED ONLY

0.51 RVUs | $18

(Facility ONLY)

Unbundled (eg reimbursed) for 2019; Patient Consent Required

99447

Interprof phone/online 11-20 – FACILITY BASED ONLY

1.00 RVUs | $36

(Facility ONLY)

Unbundled (eg reimbursed) for 2019; Patient Consent Required

99448

Interprof phone/online 21-30 – FACILTY BASED ONLY

1.51 RVUs | $54

(Facility ONLY)

Unbundled (eg reimbursed) for 2019; Patient Consent Required

99449

Interprof phone/online 31/> FACILITY BASED ONLY

2.02 RVUs | $72

(Facility ONLY)

Unbundled (eg reimbursed) for 2019; Patient Consent Required

[1]  Estimated reimbursement calculated based on the proposed RBRVS (resource-based relative value scale) which proposes to value one RVU (relative value unit) at $36.04 for 2019, estimates are rounded down to a whole dollar amount.