New codes from the AMA could mean more RPM reimbursement by 2025

New codes from the AMA could mean more RPM reimbursement by 2025

If the American Medical Association approves new changes and Medicare and private payers follow suit, providers that expand their remote patient monitoring programs to fit the new codes will gain the most benefits for their patients and clinics.

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The current remote patient monitoring (RPM) services are billed under four Current Procedural Terminology (CPT) codes, divided into RPM device monitoring and timed RPM management service categories. Medicare and some state Medicaid programs cover RPM, along with various commercial payers. Proposed changes to RPM coding by the American Medical Association (AMA) include:

Adding a new code to cover two to 15 calendar days of collected and transmitted data, allowing billing for periods with fewer than 16 readings, which is currently required for CPT 99454.

Revising CPT 99457 to include 11-20 minutes of RPM care management time, reducing the requirement from the current 20 minutes.

Revising CPT 99458 to cover each additional 10 minutes of interactive communication, reducing the required additional time from the current 20 minutes.

The rationale for these changes includes the need to balance billing restrictions with program innovation, based on evolving clinical research showing the benefits of RPM. These changes aim to promote higher RPM adoption, flexibility, and appropriate reimbursement for providers while guarding against unreasonable monitoring programs.

If approved, these changes could significantly expand the scope of RPM programs, benefiting both existing and new programs. Medicare and private payers may align their coding rules with AMA changes, likely resulting in coverage changes by 2025 or later.

The proposed changes reflect the AMA's acknowledgment of the value of remote care management services and its efforts to address healthcare disparities, especially in rural areas. Expanding RPM codes could help bridge the gap in care and encourage further adoption, potentially benefiting both patients and providers.

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