AMA Backtracks on RPM Codeset Revisions, but There Is Some Good News

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by Daniel Tashnek

The American Medical Association (AMA) held its highly anticipated May 2024 CPT Editorial Panel meeting last week in Chicago and among the topics discussed was a potentially significant overhaul of the remote patient monitoring (RPM) codeset. Today, physicians must collect RPM data on at least 16 days of a 30-day period or spend at least 20 minutes interacting with a patient per 30 days to receive reimbursement. The changes AMA was considering would have allowed for billing for 2 to 15 days of data and 11 to 20 minutes of patient interaction. We covered the details on the proposed changes and their potential impact in the lead-up to the May meeting.

During the CPT panel's initial deliberation on the proposed RPM changes, the members appeared close to agreeing on updating the codeset. These updates included modifying the 16-day data requirement, which has been challenging for both providers and patients. However, as the discussion progressed, the panel got caught up in minutiae and failed to reach the consensus needed to approve any changes. Ultimately, the members voted to postpone a vote on the changes to a future meeting. One committee member suggested that incorporating some of the feedback discussed could lead to considering other codeset revisions past what was under consideration this time around. The next CPT Editorial Panel meeting is scheduled for September 19-21, 2024, and we at Prevounce will be monitoring it closely for any indication that RPM codes will be on its agenda.

The committee’s decision to kick the can on a much-needed overhaul of RPM codes was certainly disappointing but not entirely unexpected. A discussion on changes to the RPM codeset was also slated for the February 2024 CPT Editorial Panel meeting, but the agenda topic was pulled at the last minute – presumably to allow for more feedback. Perhaps the live discussion in May will lead to more productive conversations in the future, and perhaps as soon as the September meeting.

What is encouraging is that we are now having spirited debates about how to revise RPM codes in a manner that will help increase patient access and improve reimbursement for remote patient monitoring. Providers, practices, and health systems have been subjected to a great deal of uncertainty as post-COVID telehealth policies have taken shape. To the benefit of patients and providers alike, RPM appears here to stay, and it is likely only a matter of time before it undergoes expansion.

 

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