CMS Expands Reimbursement for Remote Patient Monitoring

| Brittany McCullough
vital sign monitor on tablet PC

I recently attended an event focused on Medicare’s reimbursement of technology-driven health tools, namely remote patient monitoring (RPM), and it was quite insightful.

RPM is often lumped into the category of telehealth, but it is a distinct service. In general, telehealth is the practice of medicine via technology while RPM is a tool that can augment care. RPM refers to the use of digital technology to collect medical and health data from individuals and electronically transmit it in a secure fashion to health providers in a different location. It essentially monitors patients while they are away from their providers, thus allowing health professionals to incorporate more information into the patient’s care plan.

Given that RPM is not subject to the same number of onerous restrictions as telehealth, it has the potential to improve care management by allowing providers to better account for a patient’s overall health.

RPM allows providers access to more information about their patients, including activity level, diet, exercise, home environment and possible social determinants of health. Having all this data instead of merely relying on the self-reported information patients give can help providers develop an appropriate treatment plan and ultimately improve clinical outcomes and lower costs. This is particularly important for patients with chronic conditions or comorbidities that are at increased risk for a serious health issue. It’s also useful in the monitoring of substance use disorders to ensure patients are adhering to medication-assisted therapy protocols and haven’t relapsed. RPM also empowers patients to be more proactive and engaged in their care because their everyday decisions will be documented.

Reimbursement for RPM under CMS hasn’t been sufficient. As one might expect, CMS is wary to reimburse for the service due to lack of sufficient evidence, and providers haven’t launched many programs due to lack of reimbursement. There have also been concerns regarding the accuracy and the sheer volume of the data provided.

However, CMS has signaled that they will increase payment for RPM with recent changes to the CPT coding system. In January 2018, CMS unbundled CPT code 99091 which allows for separate payment for the collection and interpretation of data provided via RPM for a minimum of thirty minutes.

The CPT Editorial Panel also approved three new CPT codes for RPM: 990X0, 990X1 and 994X9. Of the three, 994X9 is the most promising because it would allow non-physicians to bill for RPM. If CMS signs off, these three new codes will be reimbursed starting in 2019.

I think CMS has suddenly gotten on board with reimbursing for RPM because many consider it to be a stepping stone to telehealth. Paying for RPM allows them to slowly enter the telehealth space to see if there is any true return on investment before completely committing themselves.

Given that Medicare reimbursement for RPM is expanding, the evidence-base for the value of RPM should also increase. Unbundling CPT code 99091 is an acknowledgement from CMS that RPM is beneficial even when not paired with live voice and video as part of telehealth. Allowing providers to bill for RPM will better align financial incentives with the growth in digital technology.

But there is still more room for improvement as commercial payors and Medicaid aren’t required to follow CPT coding rules. Once there is enough data to support the value of RPM, universal reimbursement for the service might be attainable. Although reimbursing for RPM alone isn’t enough to markedly move the needle for telehealth, CMS’s willingness to allow some flexibility should be applauded. Any signal from any payor, especially CMS, that they support the use of technology in healthcare is progress.

Brittany McCullough photo

Brittany McCullough, Health Policy Specialist.

Brittany McCullough, URAC's health policy specialist, focuses on tracking and analyzing legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external engagement. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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