Remote peak flow monitoring is commonly used to monitor asthma and COPD. Patients enrolled in a remote therapeutic monitoring (RTM) program will use an FDA-cleared peak flow meter device. The service is covered under Medicare and eligible for reimbursement. This article summarizes the proper procedures for billing for remote therapeutic monitoring services according to the Centers for Medicaid and Medicare Services (CMS) guidelines.
Remote Peak Flow Monitoring Overview
Digital RTM spirometers and peak flow meters are handheld remote therapeutic monitoring devices that measure peak expiratory flow using Bluetooth or cellular connections. When patient measurement is captured by the remote peak flow monitoring medical device, it is transmitted securely to a clinician’s software portal. Many RTM devices are easy-to-use tools that help engage active participation in care management.
Medicare Reimbursement
Healthcare organizations must follow CMS remote therapeutic monitoring billing guidelines to ensure proper reimbursement. Medicare covers remote monitoring services for chronic care populations and patients not close to medical professionals due to geographic location. Remote peak flow monitoring uses the CPT codes listed below. These are the same CPT codes used for remote therapeutic monitoring services that utilize spirometers, smart pillboxes, and inhaler usage tracking devices.
98975
This code is billed after 16 days of monitoring and is used for initial enrollment, setup, and patient education on using equipment for RTM. The average rounded national payment rate is $19.73.
99876
CPT 99876 pays for supplying the RTM device for respiratory system monitoring. This code may be used more than once, given that the patient uses the device at least 16 days a month. The average rounded national payment rate is $43.03.
98980
This code covers the first 20 minutes of clinical staff time communicating with a patient or caregiver. A portion of the 20 minutes must involve interactive remote communication with the patient by video call, phone call, email, or text messaging. The average rounded national payment rate for this code is $50.15.
When using code 98980 for remote peak flow monitoring, it is billed monthly and can be billed ‘incident to’ under general supervision. Therefore, Medicare providers can contract third-party RTM companies to assist with services. This opportunity allows clinicians to manage more patients, resulting in more company revenue without significantly impacting workflow.
98981
Code 98981 is used for 20 minutes of clinical staff time for communicating with the patient or a caregiver. Documentation of how the time is distributed is required. The average national payment rate for CPT 98981 is $39.14.
Medicaid Reimbursement for Remote Peak Flow Monitoring
Medicaid coverage varies from state to state. For example, some state Medicaid programs limit the types of facilities allowed to claim reimbursements and the kind of device that can be used. When initiating remote peak flow monitoring, it is important to check your states Medicaid policy. The Center for Connected Health Policy (CCHP) tracks and compiles telehealth-related laws and regulations across all 50 states, the District of Columbia, and the federal level. The CCHP website has up-to-date information for Medicaid reimbursement in your state.
Remote Peak Flow Monitoring for Chronic Care Companies
Remote monitoring is used to manage a host of common respiratory diseases. Today, effective telehealth and remote monitoring programs play a vital role in chronic respiratory disease management. Schedule a complimentary demo to learn how Tenovi remote respiratory monitoring solutions benefit patients, chronic care companies, and clinicians.
