The Centers for Medicare and Medicaid Services released the 2020 Medicare Physician Fee Schedule Final Rule last November 1, 2019. This update gives more information on policies, rates, and additional provisions for chronic care management services starting January 1, 2020.
According to the 2020 Physician Fee Schedule, there will be an increase in reimbursement for chronic care remote physiologic monitoring services. At the same time, there will be a decrease in supervision requirements for RPM services like the collecting, analyzing, and interpreting of digital data on patient physiology.
What is new in the 2020 Physician Fee Schedule?
With CPT code 99457, a health care professional can deliver remote monitoring and treatment management. Clinical staff, physicians, or other qualified professionals can provide comprehensive monitoring and interactive communication with the patient for about 20 minutes every month. Billing for 99457 is at $51.63.
Meanwhile, CPT code 99458 accounts for the additional 20 minutes the health professional spends with the patient. You can use this code up to two times a month, billable for $42.23 in each instance. This scheme is most beneficial to patients who require more contact in a month, and it mimics the requirements of CCM.
How will the new codes affect the delivery of services?
There are plenty of implications of this new schedule. For example, medical professionals could give RPM services to a heart failure patient using a WCD, or a wearable cardioverter-defibrillator. The WCD will get data and posts it on an online management system, which monitors how they respond to therapy, as well as their health status. Information like this is vital in the months after a cardiac incident.
RPM services also stand to benefit from physician-provided equipment, which you could bill through code 99454. This is aside from the new RPM code, 99458, which covers up to 20 additional minutes of RPM after the initial 20. Medical professionals can also attach this to 99457 if the activities cover 40 minutes of services delivered in a calendar month.
You can also furnish RPM Codes 99457 and 99458 under general supervision, a significant difference from the 2019 requirement for direct supervision. With this development, providers can outsource their functions to a team that will monitor patients and send computations back.
What else to know about the new schedule
Apart from having new codes, the 2020 Physician Fee Schedule also has a reduced physician supervision requirement for RPM services. Under the new scheme, chronic care management staff can provide RPM services even if there is no doctor in the office.
Note that in the 2020 scheme, RHCs and FQHCs are not separately billable. It is because both are part of the RHC All-Inclusive Rate, or AIR, and the Prospective Payment System, or PPS payment. Also, the CMS has stated that services obtained will only need a single annual consent.
There have been plenty of changes in remote chronic care management since the start of the year. From new codes to additional guidelines and reclassifications, CMS is always looking for ways to provide more accessible care for the most vulnerable demographics.
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