Good news for RPM providers, though correction does not address supervision requirements
On March 14, 2019, CMS issued “Technical Corrections” to address errors in the 2019 Final Medicare Physician Fee Schedule (“MPFS”) published on November 23, 2018. One of these corrections has important implications for Remote Patient Monitoring under CPT Code 99457.
CCRPM Performed by “Auxiliary Personnel”
As we noted in our prior post on Chronic Care Remote Patient Monitoring, the 2019 Final MPFS states that CPT Code 99457 describes only professional time and “therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services.” We went on to note that “[t]his position also appears to contradict the descriptor of the code itself, which states the services can be furnished by clinical staff.” Based on industry feedback and request for clarification, CMS agreed to examine the issue more closely and issued the correction, which states:
“On page 59575, column 3, 3rd full paragraph we are removing the sentence, “We note that CPT code 99457 describes professional time and therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services” and adding in its place, “We thank commenters and confirm that these services may be furnished by auxiliary personnel incident to a practitioner’s professional service.”
Therefore, we can now confirm that CPT Code 99457 can be billed if the work is performed by non-practitioners working “incident to”. This, however, begs the question - what kind of supervision is required. Unfortunately, the answer to that remains open to debate.
“Incident To” billing and Direct Supervision versus General Supervision
Notably, neither the 2019 Final MPFS nor the Technical Correction addresses the issue of Direct versus General supervision requirements for “Incident To” billing of Remote Patient Monitoring services. Medicare typically reimburses for services performed by clinical staff that are “incident to” or integral to a physician’s (or other billing practitioner’s) professional services during the course of treatment as long as certain criteria are met. Generally, “incident to” billing requires direct supervision of clinical staff performing these services by a physician (or other billing practitioner) in the same physical office space as the clinical staff.
However, for some services, such as Chronic Care Management and Transitional Care Management, CMS has allowed “incident to” billing under general supervision of clinical staff by a billing practitioner that is employed or contracted by the physician practice, whereby the billing practitioner need not be located in the same physical location as clinical staff performing non-face-to-face services. In allowing for Chronic Care Management and Transitional Care Management services to be billed “incident to” under general supervision of the billing practitioner, CMS reasoned that CCM and TCM services are NOT, by their very definition, provided face-to-face — with the notable exception of the initiating visit, which MUST be conducted face-to-face by the billing practitioner. This has allowed for the evolution of business models that outsource the provision of non-face-to-face CCM and TCM services to clinical staff who are contracted with the medical practice but are not physically located in the same office as the billing practitioner.
The same rationale would seem to hold true for providers of Remote Patient Monitoring Services. RPM by its very nature takes place remotely and, aside from the face-to-face initiating visit requirement, would seem to lend itself well to business models that outsource the monitoring of patient data to clinical staff, thereby eliminating any additional burden that monitoring might impose on the practice’s in-office clinical staff. However, under current Medicare rules, the default for “incident to” billing is the direct supervision requirement. While CMS could address this issue via the formal guidance promised in the 2019 MPFS, it is probably more likely to arise in the context of the Proposed Rule for the 2020 MPFS.
Please contact us for more information on Remote Patient Monitoring and, when the time comes, submission of comments in response to the proposed 2020 MPFS.
READ MORE ABOUT THE 2019 FEE SCHEDULE CHANGES RELATED TO Virtual Check Ins, Remote Evaluation of Image and Video , Virtual Consults between Physicians, or contact Nixon Law Group to learn how we can help you implement these new codes.