Update on CMS Payment Decisions – Two Steps Forward, One Back

American Telemedicine Association – November 01, 2014 – The American Telemedicine Association (ATA) announced the latest decisions of the Centers for Medicaid and Medicare (CMS) regarding funding for remote patient services. As announced, starting in January 2015, CMS agreed with ATA’s prior request for telemedicine reimbursement, as a telehealth service, seven new covered services for telehealth including annual wellness visits, psychotherapy services, and prolonged services in the office.

Also in the announcement, CMS added a new Current Procedural Terminology (CPT) service code, 99490 for chronic care patient management. This is not a telehealth code and does not require the patient to be present so it is available to be used for any patient, regardless of location.

We reported that this code could be bundled with CPT code 99091 for collecting and reviewing patient data (which is valued at $56.92 on the books). However, it turns out that CMS will still not allow any additional payments for this service. The agency will allow providers to count the time they spend reviewing data towards the monthly minimum time for billing the chronic care management code. CMS expects that this accommodation will enhance the utilization of the 99490 service.

So, while CMS has once again not allowed payment for data collection, the battle has taken a small but significant turn. First, CMS has agreed that data collection is a valuable service and should be incorporated into chronic care management. Second, there are two valuable service codes on the books:

  • 99090 – Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data)
  • 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

ATA will continue to pursue payment of the service component of remote patient monitoring with Congress and CMS. Initial payment of remote patient monitoring under Medicare is an important part of the Medicare Telehealth Parity Act (H.R. 5380) introduced by Rep. Mike Thompson with 4 bipartisan cosponsors. This provision was highlighted as a top priority by ATA and 12 other organizations in a recent letter to a Congressional committee that is developing a bill for telehealth and other health technology needs.

Media Contact:
Mimi Hubbard
mhubbard [@]americantelemed[dot]org

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