CONNECTED HEALTH CONFERENCE • Boston, MA • October 25-27, 2017

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2017 Connected Health Conference

Boston, MA
Oct. 25-27, 2017

Newly Approved CPT Codes on Chronic Care Remote Monitoring

At the end of last week, the cumulative work of PCHAlliance members and the connected health community led to real progress in modernizing U.S. health care reimbursement to include evidence based remote patient monitoring of patients with chronic conditions.  

What happened:  The Current Procedural Terminology (CPT®) Editorial Board voted to adopt a set of three CPT codes on chronic care remote monitoring!   

With this vote the CPT® Editorial Board formally acknowledged the substantial clinical evidence demonstrating the efficacy of remote patient monitoring and took the first step to create clear and useable procedure codes that may be used for billing by physicians.  The pilots, publications and clinical work diligently conducted by connected health entities was crucial to supporting the creation and formal acceptance of these codes.

"This is a breakthrough, foundational moment towards the widespread use of remote patient monitoring in the practice of medicine. A monumental medical validation of remote patient monitoring services. Hope that CMS will follow through with separate coverage for general RPM services as soon as practical." According to PCHAlliance USPSWG Member Robert Jarrin of Qualcomm.

These codes will be included in the CPT code set and made available to all healthcare professionals starting on January 1, 2019.  These codes will replace the decade-old CPT code 99090, which is seldom used and is not reimbursed by Medicare.  The three codes will represent the following (abbreviated – and pending final posting by CPT on or about August 2018):

  • 990X0: set-up and patient education on use of equipment;
  • 990X1: device supply with daily recordings or programmed alerts transmission;
  • 994X9: remote physiologic monitoring treatment management services. 

The next step is for the AMA’s RUC (Relative Value Scale Update Committee) to work with medical specialty societies to develop accurate valuations and utilization figures for these services.  In addition, the RUC makes recommendations to CMS on valuation of the codes for Medicare.  This is a lengthy and rigorous process in which providers share data and information on the resources and clinical time associated with the delivery of the three defined components to remote patient monitoring for those with chronic conditions.  The data on costs and clinical time associated with delivery of remote patient monitoring will be crucial.  This information has been kept and presented by several key providers including, PCHAlliance Member ChristusHealth, University of Virginia’s Broadband project; and the University of Mississippi Telehealth Center.  The USPSWG will be conducting outreach to identify additional providers who can share data on the clinical time and resources required to provide remote patient monitoring to ensure accurate valuation.

The summary of the CPT Editorial Panel September 2017 proceedings can be found here

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