Although the Centers for Medicare and Medicaid Services (CMS) has included coverage for'remote therapeutic monitoring' services in its proposed 2022 Physician Fee Schedule, there are still questions about reimbursement for health systems that have implemented remote multiparameter patient monitor  programs.

Monday, July 19, 2021Although remote portable patient monitor  is becoming increasingly popular among health-care organizations across the country, its reimbursement by Medicare is still a work in progress.

For what the Centers for Medicare Medicaid Services refers to as "remote therapeutic monitoring," a new category of CPT codes has been included in its proposed 2022 Physician Fee Schedule to address the need for such services. In addition, while it expands coverage for some new services in addition to the remote physiological monitoring codes that were introduced in 2019, connected health advocates say the addition of new codes raises numerous questions that will need to be addressed when the final draft is released.

CMS has proposed the following CPT codes for reimbursement for RTM services, which are based on guidelines established by the American Medical Association's Digital Medicine Payment Advisory Group over the past year:

In conjunction with the RPM codes, which were introduced by CMS earlier this year, the RTM codes provide healthcare providers with greater reimbursement opportunities in remote bedside multiparameter patient monitor  programs, both in terms of data collected and in terms of who is able to collect and use that data. Experts, on the other hand, who have examined the proposed codes say they are far from complete.

According to Nathaniel Lacktman, a partner with the law firm Foley Lardner and chair of the firm's Telemedicine Digital Health Industry Team, and Thomas Ferrante, also of Foley Lardner, in a blog post published last week, "The CMS proposed rule advances the ability of clinicians to use remote monitoring technologies to improve the patient care experience, but the technical details still need to be ironed out."

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According to Carrie Nixon, a managing partner at Nixon Gwilt Law, "While this new code set is welcomed by advocates for virtual care, the 2022 Proposed MPFS that discusses RTM may raise just as many questions as patient monitor answers," she writes in a separate blog.

The next two months will be critical, as CMS will accept comments on the proposed PFS until 5 p. m. ET on September 13, which will be the deadline for submissions. In the past, the agency has used the comments received from patient monitors to make necessary revisions to its original draft.

For the time being, Nixon notes that one of the positives is that CMS is proposing to reimburse RTM service codes 989X4 and 989X5 at the same rate as it reimburses RPM services in codes 99457 and 99458, which are currently the case.

"This is fantastic news for therapists and other Qualified Health Care Professionals (QHCPs)," says the expert in question.