The Current Procedural Terminology (CPT) code set drives communication across health care by enabling seamless processing and advanced analytics for medical services and procedures. Join the discussion to learn about the CPT process, how you can get involved, and what it means for the future of medicine (including digital health, E&M, and more!).
Does the CPT code selected depend on the patient's diagnosis or the kind of service delivered?
Are there other requirements in order for the billing to go through? (e.g. patient sign-off, etc.)
With COVID-19, for example, there is opportunity and need for remote symptomatic monitoring rather than strictly vital monitoring. Is it known if symptom monitoring can be successfully billed or is CMS looking for particular vitals (e.g. BP, HR, ECG, etc.) to be digitally transmitted between patient and care team?
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He/Him/His
Excellent question Jake.
In 2019, the CPT Editorial Panel published three new codes (with an additional add-on code published in 2020) to better describe remote physiologic monitoring services.
CPT code 99453 describes the initial patient set-up and education on the use of the device (Report this code only once per episode of care).
CPT code 99454 describes the device supply. (Report this code when the physician’s office owns the equipment and distributes it to the patient.) The typical scenario for this service was for heart failure patient physiologic monitoring.
CPT codes 99457 and 99458 – These codes describe physiologic monitoring of a patient (99457 = first 20 minutes and 99458 = each additional 20 minutes). 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. Codes 99457, 99458 require a live, interactive communication with the patient/caregiver. Report 99457 one time regardless of the number of physiologic monitoring modalities performed in a given calendar month.
Note that CPT Coding guidelines may differ from third party payer guidelines. Eligibility for payment and coverage policy are determined by each individual insurer or third-party payer. For reimbursement or third-party payer policy issues, contact your local third-party payer.
If you have questions regarding the appropriate CPT code use around a particular device, or in a specific clinical scenario, we invite you to submit that question to our Knowledge Base for the CPT Network, and submit the details to our CPT coding experts to review. You can access the CPT Network at ama-assn.org/practice-manageme....
She/Her/Hers
Zach, Thanks for the definitions of the remote physiologic monitoring. What is considered a physiologic parameter that can be monitored with these codes? Is it BP, weight, heart monitor or can it be some other diagnostic testing that can be transmitted to the physician in the office from the patient at home on their cell phone app?
Stephanie, also see CPT code 99091 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
Experts: how can one submit requests for changes to the CPT code set?
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He/Him/His
Over the past two years, the CPT Editorial Panel has modernized its application submission process. The CPT® Smart App, the first all-digital CPT application, officially launched last year. Visit: ama-assn.org/practice-manageme... and click on “CPT Smart App” to browse the streamlined application process and/or submit your CPT application today.
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For in-home home health visits, the CPT code will vary depending on the reason or need for the approved visit (i.e., kind of service) in most, if not all cases.
As for the other requirements for billing, they will vary based on the federal requirements down to varying state requirements. Typical required paperwork includes care plans, authorizations, and Oasis assessments for Medicare. Providers should look at their requirements to be certified for home health and check with the payers to which they will be submitting the claims for additional information of what all of the requirements are.