On August 3, 2020, the Center for Medicare and Medicaid Services (CMS) released a Medicare Physician Fee Schedule Proposed Rule for 2021, which includes possible updates to remote patient monitoring policies.
This article will explore the potential changes in the 2021 remote patient monitoring proposed rule that may be in store and its implications.
Remote Patient Monitoring Proposed Rule Policy Changes
While the 2021 proposed rule did not contain any new CPT codes, many ambiguities in current remote patient monitoring regulations were clarified.
The document specifies who can perform RPM services, who can receive RPM services, how time must be spent, and what devices can be used.
Summarized below are Medicare’s proposed changes to remote patient monitoring and their significance:
1) Clarification of What “Live-Interactive Communication” Means
CPT 99457 and 99458 both require live interactive communication with the patient. This code covers 20 minutes of data review and interaction with the patient.
In the proposed rule, CMS specifies that live-interactive communication must consist of “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 calls and video calls would suffice. However, email or text messaging would not count.
2) Requiring 20 Minutes of Live Interaction
Another proposed clarification for CPT 99457 and 99458 is that “interactive communication must total at least 20 minutes of interactive time with the patient over the course of a calendar month.”
Prior to this proposal, it was assumed that interactive communication with the patient only needed to make up part of the 20 minutes. The rest of the time would account for other tasks like reviewing patient data and making adjustments to treatment plans.
As a result, it appears that clinicians would only be reimbursed for more live interaction with the patient, not the time it takes to analyze and act upon the data.
3) Medical Device Only Needs to Fit the FDA’s Definition of a Medical Device
The medical device used for remote patient monitoring must fit within the FDA’s definition of a medical device, which can be found in section 201(h) of the Federal, Food, Drug and Cosmetic Act.
This means that the device does not need to be FDA cleared. However, there are some requirements:
- First, the device should automatically upload patient data. The patient should not be recording or sending pictures of the data shown on the device.
- Additionally, the device must reasonably apply to treatment for the patient’s condition.
- Lastly, the device must collect and transmit accurate data to help the clinician effectively monitor the patient and adjust treatment plans.
4) RPM Can Be Used for Acute and Chronic Conditions
When CPT 99453, 99454, and 99457 were introduced in 2019, remote patient monitoring was intended for patients with chronic conditions.
CMS clarifies in the proposed rule for the 2021 Physician Fee Schedule that remote patient monitoring is also available for patients with acute conditions.
Generally, acute conditions develop suddenly and quickly. Remote patient monitoring would enable patients to get the timely assistance they need to minimize complications.
5) Clarification that Remote Patient Monitoring is an Evaluation and Management (E/M) Service
Another 2021 proposal is to clarify that RPM is an E/M service.
As a result, only physicians or non-physician practitioners that are eligible to provide E/M services can bill Medicare for remote patient monitoring services.
6) Determining Who Can Perform Services for CPT 99453 and 99454
Unlike CPT 99457 and 99458, CPT 99453 and 99454 do not specify who can perform device set-up and patient education services.
In the proposed rule, CMS clarifies that CPT 99453 “is valued to reflect clinical staff time.”
However, they are also proposing to allow auxiliary personnel (which also includes non-clinical staff) to provide services for the 2 codes under general supervision of the billing physician.
Pandemic-Related RPM Policy Changes for 2021
Due to the COVID-19 pandemic, remote patient monitoring guidelines have become more flexible. These policy changes were created to minimize COVID-19 exposure and enhance access to services. In the proposed rule for the 2021 Physician Fee Schedule, CMS addressed which policy changes would only last for the duration of the public health emergency and which would be permanent.
CMS has proposed to permanently allow consent to be obtained at the time remote patient monitoring services are furnished. Guidelines that will only be in effect for the duration of the pandemic include:
- Furnishing RPM services to new, unestablished patients
- Allowing 2 days of device use for COVID-19 patients instead of the usual 16 days
- Option to waive copays
Providing Feedback on the 2021 Proposed Rule
The Physical Fee Schedule Final Rule, which contains the official remote patient monitoring policy updates, will be released towards the end of the year.
CMS welcomes comments from the public addressing:
- whether the current CPT codes address a full range of scenarios where RPM services may be useful
- if additional CPT codes to reimburse a shorter duration of device-use for acute conditions would be beneficial
To find out how to submit a comment, refer to page 2 of the 2021 Proposed Medicare Physician Fee Schedule. Comments will be accepted through October 5, 2020.
