With the release of the 2021 Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS) finalized its 2021 remote patient monitoring policies. This article will go over 10 major remote patient monitoring policy updates set to take effect on January 1, 2021.
2021 Remote Patient Monitoring Updates
No new CPT codes were added for 2021 remote patient monitoring, but CMS did make several clarifications to existing regulations.
1. The medical device must meet the FDA’s definition of a medical device
The 2021 Physician Fee Schedule Final Rule clarifies what constitutes an acceptable medical device for remote patient monitoring services.
While the device does not need to be FDA-approved, CMS specifies that the device must meet the FDA’s definition of a medical device as described in Section 201(h) of the Federal, Food, Drug and Cosmetic Act.
The device must:
- Automatically upload patient data (the patient should not be self-recording or sending pictures of data shown on their device)
- Reasonably apply to treatment for the patient’s condition
- Collect and transmit accurate and reliable data (to allow the clinician to effectively monitor and manage the patient’s treatment plan)
2. Auxiliary personnel can furnish services for CPT 99453 and 99454
CPT code 99453 covers the time spent instructing patients how to use the medical device and CPT 99454 covers the supply of the device for daily recording or programmed alert transmissions.
The 2021 final rule confirmed that auxiliary personnel (any employee who is acting under the general supervision of the billing physician or practitioner) can furnish the services of CPT codes 99453 and 99454.
3. Physical, occupational, and behavioral health therapists may not bill for RPM services
CMS clarified that remote patient monitoring is an Evaluation and Management (E/M) service.
Therefore, RPM CPT codes (99453, 99454, 99091, 99457, and 99458) can only be billed by physicians or non-physician practitioners (nurse practitioners or physician assistants) that are eligible to bill Medicare for E/M services.
4. RPM services can be provided for chronic and acute conditions
Although RPM services were initially intended for patients with chronic conditions, CMS now allows clinicians to furnish RPM services for individuals with acute conditions.
5. CPT 99091 and 99457 can be billed together
Prior to the release of the 2021 final rule, CPT codes 99091 and 99457 were not allowed to be billed together.
These two codes primarily differ in regards to how much time is required and who must analyze the data.
CMS clarifies that “in some instances when complex data are collected, more time devoted exclusively to data analysis and interpretation by a physician or NPP may be necessary such that the criteria could be met to bill for both CPT codes 99091 and 99457 within a 30-day period.”
6. Clarification of what constitutes “interactive communication” for CPT 99457 and 99458
CMS clarifies that “interactive communication” for purposes of CPT codes 99457 and 99458 involves “a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.”
Therefore, communication methods like phone and video calls would suffice. However, email or text message would not.
7. Clarification of what the 20-minutes required to bill CPT 99457 and 99458 covers
In the proposed rule, CMS suggested that the entire 20 minutes required to bill for CPT 99457 and 99458 should consist of interactive communication with the patient.
This was met with large opposition as the code no longer covered the costs of interpreting the data and managing care plans.
The final rule clarifies that the 20-minutes “can include time for furnishing care management services as well as for the required interactive communication.”
8. Consent to receive RPM services may be obtained at the time RPM services are furnished
During the COVID-19 public health emergency, CMS allowed patient consent for RPM services to be obtained at the services were provided. This regulation has been made permanent and is therefore no longer subject to change after the pandemic ceases.
9. Allowing a minimum of 2 days of data collection (temporary)
During the COVID-19 public health emergency, CMS allowed RPM codes to be billed for a minimum of 2 days of data collection over a 30-day period, instead of the 16 days stated in the 2020 Physician Fee Schedule.
The final rule clarifies that after the public health emergency ends, the requirement for 16 days of data each 30 days will be reinstated.
10. Physicians can order RPM services for new patients (temporary)
During the COVID-19 public health emergency, CMS allowed physicians to furnish RPM services for new and established patients.
The final rule clarified that after the public health emergency ends, they will reinstate the requirement that RPM services be provided only to established patients.
Changes to Remote Patient Monitoring for 2021: Key Points
The 2021 Physician Fee Schedule final rule clears up some ambiguities for RPM by defining what constitutes a medical device, who can bill for and provide RPM services, and what modes of communication are acceptable.
Further, it clarifies which policies made in response to the COVID-19 public health emergency will be permanent or temporary.
These changes will take effect on January 1, 2021. To view the complete final rule, click here.
