With the addition of three new billing reimbursement codes for remote patient monitoring by the Centers for Medicare and Medicaid Services (CMS) in 2019, glaucoma treatment just got less expensive for ophthalmologists and their patients.
So, what does this mean for you, as an eye care professional? How can you take advantage of these changes to incorporate the Icare Home Tonometer into your glaucoma treatment plans? We’ll explain everything you need to know.
How does Medicare define remote patient monitoring?
Remote patient monitoring uses digital technologies to collect health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. The Icare Home Tonometer is an example of this technology.
To be eligible for the new billing codes, remote patient monitoring must be associated with chronic care management of two or more serious conditions expected to last at least a year. For example, a patient may have moderate to severe glaucoma with above-average risk for disease progression with another co-existing chronic condition – either systemic or ophthalmic.
What are the new billing codes for remote patient monitoring?
As of Jan. 1, 2019, these three billing codes are included in the Medicare Physician Fee Schedule.
- 99453 – Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup and patient education on use of equipment
- 99454 – Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
- 99457 – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month. The 20-minute requirement is cumulative throughout the month of physician and staff time.
How much will Medicare reimburse?
In 2019, the national Medicare Physician Fee Schedule allowable amounts are:
- 99453 $19 (reported only once per episode of care; do not report for monitoring of less than 16 days)
- 99454 $64 (report once at the end of each month; do not report for monitoring of less than 16 days)
- 99457 $52 (report once each 30 days, regardless of the number of parameters monitored)
The payment amounts are adjusted by local wage indices. Like most Medicare covered services, these amounts are subject to annual deductibles and copayments.
How can you ensure the use of the Icare Home Tonometer is covered under these new codes?
As noted above, candidates for remote patient monitoring using the Icare HOME must be Medicare beneficiaries currently under care of an ophthalmologist or optometrist for two or more serious conditions, one of which is glaucoma, who would benefit significantly from chronic care management.
After a thorough eye exam, you should provide the patient with a detailed, written explanation, which should include a provision to stop at any time. You’ll need to record the IOP data, interpretation, and physician treatment plan in a structured chart note.
Your staff must follow a strict billing protocol for chronic care management. And even though ophthalmic technicians or medical assistants play an important role, their activities are subject to direct supervision. The physician or other qualified health care professional (in this case the optometrist or ophthalmologist) must be present in the same location where the services are occurring.
When should I not use the new billing codes?
There are few scenarios:
- CPT code 99457 cannot be reported in conjunction with 99091 (Collection and interpretation of physiologic data) or on the same day as an eye exam.
- 99490 (Chronic care management) is a complementary service, but time spent performing these services should remain separate and not be counted twice.
The American Academy of Ophthalmology expects the recognition and reimbursement for telemedicine options to continue. “The rapid improvement of electronic imaging capability and biometric data acquisition in ophthalmology, combined with parallel advancements in health information technology and widely available broadband connectivity, has created new pathways for delivery of eye care services.”
Fortunately, with the addition of these new billing codes, these pathways will now be more accessible to the patients who need them most.
For more information on the new billing codes for remote patient management, check out the Centers for Medicare and Medicaid Services fact sheet. Or contact us today to see how we can help.