News: CMS proposes 12% cut to CPT codes that support remote patient monitoring

CDI Strategies - Volume 16, Issue 36

As more and more health systems and hospitals have looked to supplement clinical visits with monitoring and managing care for patients at home, remote patient monitoring (RPM) programs have grown in popularity. Medicare coverage for RPM services was already limited, but CMS’ proposed 2023 Medicare Physician Fee Schedule includes a 12% reduction in reimbursement for current procedural terminology (CPT) codes supporting RPM. Many telehealth companies that have rapidly grown in the RPM space since the COVID-19 pandemic have expressed concerns the proposed cuts could endanger those services, Healthleaders reported.

"By driving better patient outcomes, we're reducing emergency room visits by up to 50% for patients who are enrolled in Cadence programs and decreasing their cost of care by $5,000 on average," Chris Altchek, the telehealth company Cadence's founder and chief executive officer, told Healthleaders in an interview. Accountable care organizations using RPM programs are seeing a 19% saving on average total cost of care, their data shows.

About a quarter of Cadence’s patient base lives in underserved areas, and it provides care management for patients with chronic health conditions such as congestive heart failure (CHF), hypertension, and type 2 diabetes. This is the same for most RPM programs. Meanwhile, CMS data shows that these conditions are prevalent in Medicare patients aged 65 years or older, with CHF at 13%, hypertension at 58%, and type 2 diabetes at 25%. This translates to high medical costs (e.g., $281 billion in 2015 for heart disease).

In its 2023 proposal, CMS includes a 12% to CPT code 99454. Currently this code reimburses providers for the transmission of data to collect vital signs from at-home patients using devices such as blood pressure cuffs, weight scales, and blood glucose monitors. CMS has scheduled a review of the cuts affecting CPT codes 99454, 99453 (patient onboarding), 99457 (first 20 minutes of monitoring and delivering care to a patient remotely), and 99458 (the next 20 minutes), to be conducted next year. If CMS reimbursements of RPM services do decline, it’s likely many telehealth companies will withdraw from serving certain regions in order to retain quality of their remote patient monitoring.

Editor’s note: To read Healthleaders’ article on this topic, click here. To read the 2023 Medicare Physician Fee Schedule, click here.

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