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RPM payer policies

Michelle Posted Fri 22nd of May, 2020 16:33:21 PM
For the new RPM cpts 99454, 99457, & 99458 could you tell me if you have specific payer policies preferably Anthem BCBS of CA, Aetna, and Blue Shield of CA. We are thinking of implementing these cpt codes in our psychiatric facility. Are these covered by a psychiatrist? Who can perform the services?
Michelle Posted Fri 22nd of May, 2020 16:36:36 PM
Also, do these codes primarily need authorization from what you are learning. I know they are brand new so we'd like as much information as you have on this. Thank you.
SuperCoder Answered Tue 26th of May, 2020 10:17:05 AM

Hello Michelle,

Hope you’re doing well!

 

Thank you for your question.

 

Please find the below information regarding CPT® code 99454, 99457, 99458

 

For CPT® code 99453 and 99454

  • Codes 99453 and 99454 are used to report remote physiologic monitoring services (e.g. weight, blood pressure, pulse oximetry) during a 30-day period.
  • To report 99453, 99454, the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional.
  • Code 99453 may be used to report the set-up and patient education on use of the device(s).
  • Code 99454 may be used to report supply of the device for daily recording or programmed alert transmissions.
  • Codes 99453, 99454 are not reported if monitoring is less than 16 days. Do not report 99453, 99454 when these services are included in other codes for the duration of time of the physiologic monitoring service (e.g. 95250 for continuous glucose monitoring requires a minimum of 72 hours of monitoring).

 

For CPT® code 99457 and 99458

  • Remote physiologic monitoring treatment management services are provided when clinical staff/physician/other qualified health care professional use the results of remote physiological monitoring to manage a patient under a specific treatment plan.
  • To report remote physiological monitoring, the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional.
  • Do not use 99457, 99458 for time that can be reported using more specific monitoring services (eg. for the patient that requires reevaluation of medication regimen and/or changes in treatment).
  • Codes 99457, 99458 may be reported during the same service period as chronic care management services (99487, 99489, 99490), transitional care management services (99495, 99496), and behavioral health integration services (99484, 99492, 99493, 99494); however, time spent performing these services should remain separate and no time should be counted toward the required time for both services in a single month.
  • Codes 99457, 99458 require a live, interactive communication with the patient/caregiver. For the first completed 20 minutes of clinical staff/physician/other qualified health care professional time in a calendar month report 99457, and report 99458 for each additional completed 20 minutes.
  • Do not report 99457, 99458 for services of less than 20 minutes.
  • Report 99457 one time regardless of the number of physiologic monitoring modalities performed in a given calendar month.

 

Coding Tip

  • Code 99457 may be reported only once each 30 days.
  • Codes 99457 and 99458 require live, interactive communication with the patient/caregiver and may only be reported once, regardless of the number of physiologic parameters monitored.

NOTE: The device used to provide these services must be a medical device as defined and approved by the United States Food and Drug Administration (FDA), and it must be ordered by a physician or other qualified health care professional.

 

Coding Tip

  • Remote physiologic monitoring treatment management (99457) is precluded from being reported for the same time period as home BP monitoring (99473).
  • Code 99457 was revised to report remote physiologic monitoring treatment management services for the first 20 minutes of service. New add-on code 99458 was established to report each additional 20 minutes of remote physiologic monitoring treatment management services in conjunction with code 99457.
  • Codes 99457 and 99458 may not be reported for services of less than 20 minutes and may not be reported for time spent on an evaluation and management service (e.g. 99291, 99292) or other monitoring services (e.g. 93290, 93793) when performed on the same day.

 

Who can perform these services?

There is no such list of practitioners rendering RPM service(s). Check it with your respective payer.

See comment on page 140 of 334 https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

 

Note: Eligibility for payment, as well as coverage policy, prior authorization is determined by each individual public or private payer. Currently, we do not have payer specific policies as requested in the above documentation. Kindly get in touch with payers for proper billing guidance.

Hope that helps!

Thanks

Michelle Posted Thu 18th of June, 2020 14:56:35 PM
How and what modifiers do we use if we are billing all of these codes monthly - When should we bill is this on the dos that we initiate or date we bill the below codes - once a month do we bill at the end of mo x unit...
Michelle Posted Thu 18th of June, 2020 14:57:28 PM
and I forgot to ask what place of service do we bill this as? We are doing out of our main office however, pts are being monitored electronically.
Michelle Posted Thu 18th of June, 2020 14:59:51 PM
And then are any of these cpts considered Incidental and can we do outsourcing of the collected data via another site a monitoring provider Also for -- what services can be used during that time Coaching for the data i e weight-loss counseling using the collected data Can we include...
SuperCoder Answered Fri 19th of June, 2020 10:16:14 AM
Hello Michelle Thank you for your additional questions nbsp In context to usage of modifier with these codes the provider s shall follow applicable modifier guidelines as per service s rendered Code is reported for each episode of care For coding remote monitoring of physiologic parameters an episode of care...

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