On July 29, 2019, the Center for Medicare and Medicaid Services (“CMS”) released its proposed rule for the 2020 Medicare Physician Fee Schedule (the “2020 MPFS”). The proposed 2020 MPFS facilitates the development of fully outsourced business models for Remote Patient Monitoring (“RPM”) services, creates a new reimbursement opportunity for additional time spent on RPM, and designates six new reimbursement codes for “e-visits.”

Reimbursement for additional time spent on Remote Patient Monitoring

In the 2019 MPFS, CMS finalized reimbursement for the newly created CPT Code 99457, requiring 20 minutes of clinical staff, physician, or qualified health care provider (“QHCP”) time aggregated during a calendar month in monitoring, evaluating, and acting on patient generated health data obtained through Remote Patient Monitoring. The proposed 2020 MPFS goes a step further and creates CPT Code 994X0, reimbursing for an additional 20 minutes of clinical staff, physician, or QHCP time spent above and beyond the initial 20 minutes provided for by CPT Code 99457. The additional time allowed by this code should prove particularly beneficial for patients requiring significant monitoring and interaction during a particular month.

General Supervision for “incident to” billing of Remote Patient Monitoring

In response to stakeholder feedback on CPT Code 99457 established by the final 2019 MPFS, CMS proposes changing the supervision requirement for “incident to” billing of clinical staff time spent on RPM services from direct supervision — whereby clinical staff must be physically located in the same place as the billing practice — to general supervision, allowing clinical staff to monitor patient data and interact with patients remotely, while escalating problems on an as-needed basis to the billing physician or QHCP. RPM services providers and healthcare professionals share the belief that RPM services can be conducted efficiently and effectively through general supervision of outsourced clinical staff located remotely, as demonstrated by the Chronic Care Management services outsourced business model.

Remote Patient Monitoring and Chronic Conditions

In proposing the change from direct to general supervision for RPM, CMS effectively designates RPM as a “care management service,” stating: “because RPM services (that is, CPT codes 99457 and 994X0) include establishing, implementing, revising, and monitoring a specific treatment plan for a patient related to one or more chronic conditions that are monitored remotely, we believe that CPT codes 99457 and 994X0 should be included as designated care management services.” It is worth noting that the implied requirement that one or more chronic conditions be present in order for RPM services to be reimbursed is contrary to CMS’ prior position on this issue. Further, the code descriptors for CPT Codes 99453, 99454, and 99457 do not include any reference to chronic conditions, whereby code descriptors for Chronic Care Management services specifically require two or more chronic conditions for reimbursement.

Reimbursement for Online Digital Evaluation Services (“e-Visits”)

The proposed 2020 MPFS creates six new non-face-to-face codes to describe and reimburse for “patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” The code descriptors refer to “online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the 7 days” and are reimbursed in increments of 5-10 minutes, 11-20 minutes, and 21 or more minutes. Three of the codes can be reported by practitioners who can independently bill E/M services, while the other three will apply to non-physician healthcare professionals who cannot independently bill these services.

Finally, CMS seeks comment on whether a single advance beneficiary consent can be obtained for certain communication-based technology services designated in the final 2019 MPFS, including virtual visits (HCPCS 2012), remote evaluation of images (HCPCS 2010), and Interprofessional Internet Consultations (CPT Codes 99446-99449, 99451 and 99452 ). CMS is considering this change in response to stakeholder feedback that obtaining advance beneficiary consent for each individual service is overly burdensome and creates a barrier for use of these services.

Comments to proposed 2020 MPFS due September 27, 2019

CMS has proven responsive to stakeholder feedback on reimbursement and implementation of RPM services, and the proposed 2020 MPFS provides another opportunity for stakeholders to have real impact on the way Remote Patient Monitoring can be used to improve patient care and reduce long-term costs. The timing of this proposed MPFS is later than expected, and this means that submitting comments sooner rather than later is of critical importance. Please contact Nixon Law Group now for assistance in drafting formal comments to the 2020 MPFS.