Reimbursement

• Remote Patient Monitoring is an extension of Chronic Care Management (CPT 99091.) Starting in 2020, the practice can make patient calls or have them performed by a qualified healthcare professional as part of an agency.  
• Although referred to as chronic care, CMS has not restricted Remote Physiologic Monitoring to chronically ill patients.
• RPM is upgraded in 2020 from a medium weighted Merit-Based Incentive Payment System (MIPS) activity to a heavily weighted activity making RPM even more valuable to the PCP in maintaining their Medicare reimbursements. 
• Medicare Advantage (Medicare Part C) plans (MA Plans) will now reimburse for Chronic Care RPM, Virtual Communications, E-Visits, and Interprofessional Internet Consultations.
• RPM is now be allowed in the Home Health system under their allowable administrative costs reports.

RPM CPT Code 99453  Reimbursement: $18.77 per set up (One time payment)
Remote monitoring of physiologic parameters: 
Patient education on equipment use performed in office (at present.) Reimbursement for the practice expense associated with furnishing RPM thus no physician work is required to bill
RPM CPT Code 99454  Reimbursement $62.44  (Monthly)
Remote monitoring of physiologic parameters: 
Device supply with daily readings or programmed alerts transmission, each 30 days. Reimbursed for the practice expense associated with furnishing RPM thus no physician work is required to bill. The minimum number of days with measurements to qualify is 16 per month.
​RPM CPT Code 99457  Reimbursement:  $51.61  (Monthly)
Remote physiologic monitoring treatment management services
The first 20 minutes of clinical staff/physician/other (auxiliary staff included) qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month including reviewing patient data.
RPM CPT Code 99458  Reimbursement:  $42.22  (Monthly)
Remote physiologic monitoring treatment management services
An additional 20 minutes or more to 99457 after satisfying the first 20 minutes..

There are 6 new codes in 2020 for the category of “E-Visits.” This provides a reimbursement for physician practices for conducting digital health assessments and evaluations for their patients. The VitalCare platform has this capability built in.  
 
HCPCS code G2061: ($12.27) Qualified nonphysician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes 
HCPCS code G2062: ($21.65) Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes 
HCPCS code G2063: ($33.92)Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
CPT code 99421: ($15.52) Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes 
CPT code 99422: ($31.04) Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes 
CPT code 99423: ($11.19) Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

​HCPCS G2010 ($12.27): Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Billable up to 7 visits per month. 

​HCPCS G2012 ($14.80 ): Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. Billable up to 7 visits per month.

​CPT 99446 ($18.41): Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review 
CPT 99447 ($37.17): Same as 99446, but 11-20 minutes of medical consultative discussion and review 
CPT 99448 ($55.58): Same as 99446, but 21-30 minutes of medical consultative discussion and review 
CPT 99449 ($73.98): Same as 99446, but 31 minutes or more of medical consultative discussion and review 
CPT 99451 ($37.53): Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 or more minutes of medical consultative time 
CPT 99452 ($37.53): Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes 

​Electrical Bioimpedance Indications CPT Code 93701
Cardiac output determined by electrical bioimpedance, also known as Thoracic Electrical Bioimpedance (TEB), is based upon the resistive changes in the thorax to an applied current. A special monitor is designed to measure impedance during the cardiac cycle after the introduction of a high-frequency, low-amplitude current using surface electrodes placed at the base of the neck and the lower chest.Since impedance changes are related to the flow of blood, both stroke volume and cardiac output can be derived. Related hemodynamic parameters such as cardiac index, index of contractility, acceleration index, thoracic fluid content and systemic vascular resistance can also be subsequently estimated.

Cardiac Output Monitoring by Electrical Bioimpedance Code 93701
Reimbursement: $25.20 per day for qualified conditions
CPT 93701 – Cardiac Output Monitoring by Electrical Bioimpedance – Electrical bioimpedance allows for noninvasive cardiac monitoring and measurement of cardiac output, stroke volume, systemic vascular resistance and thoracic fluid content. $25.20 CMS Medicare Allowable
CPT 93040 – ECG 1-3 with interpretation and report $12.97 CMS Medicare Allowable      
CPT 93041 – ECG 1-3 tracing only without interpretation $5.77 CMS Medicare Allowable  
CPT 93042 – ECG 1-3 interpretation and report only $7.21 CMS Medicare Allowable  
CPT 11100 – Lead Replacement $0.00 CMS Medicare Allowable  (reimbursement to be determined)
​ ICD-10-CM Description Level
   
I50.9                  CHF Unspecified All Levels
I50.9 – I50.814 Heart Failure All Levels
I25.10               Cardiovascular Disease Unspecified All Levels
Q24.9               Congenital Cardiovascular Disease All Levels
I11.0                 Hypertensive Disease All Levels
I42.9                 Cardiomyopathy All Levels
I48.91               Atrial Fibrillation All Levels
I63.9                 Stroke All Levels
I24.1 – I30         Acute Pericarditis All Levels
I26 – I28            Disease of Pulmonary Circulation All Levels
I51.4                  Acute Myocarditis All Levels
E00 – E07          Disease of Thyroid Gland All Levels
E87.5                 Hyperpotassemia All Levels
I65.23               Carotid Artery Occlusion All Levels
I65.29               Carotid Artery Stenosis All Levels
I67.2                 Cerebral Atherosclerosis All Levels
Z82.49              Ischemic Heart Disease All Levels
R00.2                Palpitations All Levels
R53                   Malaise and Fatigue All Levels
R42                    Dizziness and Giddiness All Levels
R06.01               Orthopnea All Levels
R06.02               Shortness of Breath All Levels
Z94.1                  Heart Transplant All Levels
Z45.01 – Z45.018 Adjustment of Cardiac Pacemaker All Levels
F19.20 – F19.21 Drug Dependency All Levels
O75.0                  Maternal Distress All Levels

Please review the CMS report for CPT 93701 code
http://www.medicarepaymentandreimbursement.com/2011/05/cpt-93701-cardiac-output-monitoring-by.html

Disclaimer: The information provided on this website is current as of January 2020 and was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content on this website is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct hospitals and/or physicians on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Telemedical Partners, LLC assumes will have been made prior to assigning codes or requesting payments.

​Under Federal and State law, it is the individual provider’s responsibility to determine appropriate coding, charges and claims for a particular service. Policies regarding appropriate coding and payment levels can vary greatly from payer to payer and change over time. Telemedical Partners, LLC recommends that providers contact their own regional payers to determine appropriate coding and charge or payment levels.