February 1, 2024 update: The AMA issued an unexpected and unusual notice that the application for the RPM code redesign had been withdrawn and would not be covered in its 2024 CPT Editorial Panel meeting. No rationale was offered, so we are working to uncover more information. Stay tuned!
The American Medical Association (AMA) has announced the agenda for its first quarter 2024 CPT Editorial Panel meeting in February, and it includes a surprising proposed full redesign of all remote patient monitoring (RPM) CPT codes.
Key takeaways include the following:
- Deleting most RPM and RTM codes. AMA is considering deleting most CPT codes currently associated with remote patient monitoring and remote therapeutic monitoring (RTM): CPT 99453, 99454, 99457, 99458, 98976, 98977, and 98978.
- Creating a combination CPT codeset for RPM/RTM management time. AMA is considering consolidating RPM and RTM services into one family of remote monitoring codes — in other words, a single CPT codeset.
- Combining measurement codes for RPM and RTM, including versions for fewer than 16 measurement days. AMA is considering simplifying the codes describing the supply of equipment by no longer using codes to describe specific medical devices for specific body systems. Rather, there would be two codes: one for 48 hours to 15 days of remote monitoring and one for 16 to 30 days of remote monitoring. If established, this would create a new code that would enable providers to code for fewer than 16 measurement days, assuming Medicare adopts the new code. AMA notes, "The 16-day requirement is a barrier, limiting access to care for patients that would benefit from shorter durations of RPM or RTM monitoring."
- Likelihood of implementation. While Medicare is not required to update its coding rules as per AMA's CPT code revisions and additions, the federal agency often does so when the association implements changes. Private payers and health plans technically have the option of not updating to new codesets, but rarely do they deviate from AMA's rules. Even if the AMA makes the changes, it is very unlikely that any coverage changes would go into effect until at least 2025.
What This Means
If AMA implements the changes under consideration, and Medicare follows suit, providers of remote patient monitoring and remote therapeutic monitoring will need to revise how they are coding and billing for RPM and RTM to ensure compliance with the new codesets and rules. The same is true for any private payers and health plans that modify their coding rules to align with AMA's changes. Providers that use remote care management technology to support coding and billing will want to ensure the vendor is keeping current with the evolving rules and making any necessary changes to the software to maintain compliant coding.
In addition, remote patient monitoring and remote therapeutic monitoring providers will want to begin coding and billing for patients who report RPM or RTM services for periods of fewer than 16 days but no less than two days (i.e., 48 hours to 15 days). This new coding and billing opportunity may further enhance the financial value and performance of a remote care management program.
Joining the Conversation
If you are interested in attending the meeting and/or sharing your thoughts with AMA on their RPM and RTM considerations, here's what you need to do:
- To register for the meeting, go here, then click "Register now."
- To submit comments, you must be identified as an "interested party." To apply to participate as an interested party, submit your request through the "Interested Party Portal" by Jan. 11, 2024. The deadline to submit written comments is noon CST on Jan. 18, 2024. Interested parties may have an opportunity to comment live during the meeting.
Prevounce will have representatives attending the CPT Editorial Panel meeting and will share any news that comes out of the meeting on social media.
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