CMS Codes Explained for Your Practice – Part One

CMS Codes Explained for Your Practice – Part One

CPT 99091: The start of Remote Patient Monitoring

In 2018, when the Centers for Medicaid and Medicare Services unbundled CPT 99091, Connected Health Initiative called it “a huge victory for telehealth innovators, connected device makers, pioneering physicians, and patients across America.”

It truly was, as it finally allowed physician practices to utilize basic connected devices to help improve the care of their patients. 

While the use of Remote Patient Monitoring has been expanded since this code was first established, it’s important to understand the basics of CPT 99091.

So, what is CPT 99091?

According to the American Medical Association, it is the “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)”

Basically, this says qualified health care professionals can bill for the collection of a patient’s data using connected devices, as long as it is for at least 30 minutes a month of time spent collecting the data.

Furthermore, the American Medical Association added:

  • Advance patient consent: practitioners must obtain advanced consent for the service and document in the patient’s record. 
  • In-person visit prior to service: for new patients or patients not seen within the year by billing practitioner, service must be initiated during an in-person visit. 
    • Includes evaluation/management services (levels 2-5), preventative physical exam, transitional care management. 
    • Does not include virtual face-to-face visit utilizing other online or telehealth modality.
  • 30-day reporting period: billing limited to once in a 30-day period. 

But, as of 2018, this has been unbundled to allow eligible practitioners  to receive separate reimbursement “for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider, at a minimum of 30 minutes of time”

Medek RPM can make sure any practice meets all the requirements of all CMS codes. We have a team of professionals who stay on top of all the changes and work with a practice’s financial team to create the best financial return for their investment.

Plus, Medek RPM’s team of care professionals works with patients directly, keeping the providers up-to-date on patients’ health status and ensuring the best care.

To learn how Medek RPM can assist your practice and your patients, please reach out to us directly.

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