September 26, 2018

The American Medical Association (AMA) has introduced new codes in the 2019 Current Procedural Terminology (CPT^®) code set that would allow physicians to bill for some remote patient monitoring services and internet consultations.

Acceptance of the new codes by the Centers for Medicare and Medicaid Services (CMS) in the 2019 Physician Fee Schedule “would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care,” AMA President Barbara L. McAneny, MD, said in a statement.

The new codes reflect the growing availability of new technological and medical advancements in mainstream clinical practice, while allowing the code set to continue to serve as healthcare’s “common language” for the reporting of medical procedures, Dr. McAneny said.

The 2019 additions include three new remote patient monitoring codes to enable clinicians to receive reimbursement for their use of technology to connect with their patients with chronic conditions and gather data for care management and coordination.

The three new codes would allow clinicians to bill for:

• The initial set-up of the monitoring equipment, including patient education on the equipment and monitoring process.
• The initial collection, transmission and report/summary services to the clinician(s) managing the patient.
• The clinician’s interpretation of the received data and interaction with the patient on a treatment plan.

Also included in the 2019 CPT codes are two new interprofessional internet consultation codes. The AMA’s CPT editorial panel added these codes to reflect the growing use of non-verbal technology in contemporary practice to coordinate communication between consulting physicians and treating physicians.

In all, the 2019 CPT code set includes 335 code changes, including new and revised codes pertaining to skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis and central nervous system assessments, including psychological and neuropsychological testing. The CPT editorial panel considered input from physicians, medical specialty groups and healthcare community stakeholders in developing and revising the codes.

Clinicians and medical organizations have been advocating for years for reimbursement for remote monitoring and telehealth services to enhance the efficiency and quality of care. To further the process, the AMA established a multidisciplinary Digital Medicine Payment Advisory Group of experts in 2017 to create a “clear pathway” for the integration of digital technology into medical practice.  The new codes are an outgrowth of their recommendations.

In a letter to CMS Administrator Seema Verma sent this past September, the AMA pointed to U.S. Census Bureau projections that more than 20 percent of U.S. residents would be 65 and older by 2030, and that the number of potential caregivers ages 45 to 64 would precipitously decline. As a result of these demographic changes, as well as significant and persistent physician shortages within some medical specialties and geographic disparities in access to care, “telehealth and remote patient monitoring will become an essential cost effective and reliable means to expand capacity,” the AMA stated.

CMS had included a separate CPT code in the 2018 Physician Fee Schedule to reimburse physicians for collecting and interpreting remote patient-generated data. However, in June of this year, 50 medical groups, health IT companies and other stakeholders sent a letter to Ms. Verma urging adoption of the AMA CPT editorial panel’s three codes for 2019.

“While CMS has taken this commendable step forward in unbundling CPT 99091 [Remote Patient Monitoring], we believe CMS must continue the commitment carefully articulated in the 2018 PFS Final Rule: to consider new digital health CPT codes created by the American Medical Association CPT Editorial Panel,” the groups wrote.

The 2019 CPT codes and descriptors can be imported into existing claims and billing software using the downloadable CPT 2019 Data File. The file contains the updated code set’s complete descriptor package, including official descriptors for consumers and physicians, and the complete official CPT coding guidelines.