New CMS codes offer great opportunity for the Vitals360

New CMS codes offer great opportunity for the Vitals360

The Centers for Medicare and Medicaid Services (CMS) officially approved three new billing codes for Remote Patient Monitoring (RPM).  Announced in November 2018, the new codes came into effect January 1, 2019.

With these new reimbursement codes, physicians are incentivized to drive more health care to the home, and leverage technology like VoCare’s Vitals360 device.

The new codes will reimburse physicians for the initial set-up and education of the patient on the new RPM equipment, as well as monthly reimbursements towards device transmission services and monthly monitoring/treatment.  This structure closely mirrors the Vitals360 business model.

The specific codes are:

  • CPT code 99453: Initial setup. Pays approximately $21. “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
  • CPT code 99454: Device/transmission fee. Pays approximately $69 per month. “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
  • CPT code 99457: Monitoring and treatment. Pays approximately $53 per month for 20 minutes of time spent viewing data and communicating with patients. “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

CPT 99457 allows RPM services to be performed not only by the physician or qualified healthcare professional, but also by “clinical staff,” such as: RNs and medical assistants. This could make it easier for healthcare providers to figure RPM programs into their workflow.

Moreover, these codes can be combined with chronic care management services (CCM), which have been active for a few years. The combined utilization of these codes provides a mechanism that family medicine providers can use to monitor and engage with patients, and to help them more efficiently manage their chronic conditions, while getting reimbursed, providing a new mechanism that innovative and savvy physician practices may be able to use to increase their quality metrics while also increasing the near term profitability of their practices.

Why is CMS doing this?
While this new mechanism creates an enormous new financial opportunity for certain types of providers (e.g. primary care providers), the new billing codes are expected to help reduce overall medical spending as a whole.

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