CMS Clarification Supports Remote Monitoring Scalability, Improves Workflows

CMS recently released a technical correction to the 2019 Physician Fee Schedule regarding CPT code 99457. The correction offered further clarification on reimbursement for remote patient monitoring.

  1. CPT code 99457 (Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month)

Three codes were introduced in January 2019 that support the implementation, provisioning, and use of remote physiological monitoring technology for patients. CPT code 99457 referred to the 20 minutes per month of clinical professional treatment management time, and when first released, the services were only allowed to be furnished by the physician / practitioner, not auxiliary personnel “incident to” a physician. This was not an ideal scenario, as many remote monitoring programs are managed by staff that report to a physician, and patients routinely monitored by nurses, and other healthcare professionals, that can triage to a physician as needed.

The technical correction stated that CPT code 99457 CAN be billed “incident to” by licensed medical professionals, under direct supervision (in the same building) of a physician. This correction allows care staff, such as nurses, to monitor patients and review data, enabling physicians to focus their efforts on patients that need the most attention. This clarification improves the scalability and workflows of remote monitoring programs and will enable more patients to receive enhanced care through remote monitoring.

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