AMA CPT® Assistant - 2018 Issue 3 (March)
Coding and Coverage Overview: Remote Patient Monitoring (99091) (March 2018)
March 2018 pages 5-6 Coding and Coverage Overview: Remote Patient Monitoring (99091) In the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) final rule, the Centers for Medicare & Medicaid Services (CMS) finalized separate payment for remote patient-monitoring services reported with CPT® code 99091. It should be noted that CPT coding guidelines may differ from CMS coding guidelines as it relates to reimbursement for services. Eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer. This article provides a historical background, CMS coverage information, and CPT guidelines for reporting 99091. Miscellaneous...
Subscribe or sign in to view the full article.
Article Overview
This March 2018 article explains the coverage and coding background for remote patient monitoring services, with a focus on CMS policy, CPT guidance, and how the service is described for reporting purposes. It is useful for coders, billing staff, compliance teams, and clinicians who work with monitoring-related services and need to understand the general framework for reporting, payment, and when other monitoring services may be relevant.
Why This Topic Matters
Remote patient monitoring services can be subject to different coverage and coding expectations depending on payer policy, so understanding the article helps reduce reporting errors and clarify when the service is addressed separately versus under other monitoring categories.
Article Sections
-
March 2018 pages 5-6
Introductory publication information and the article’s scope within a CMS and CPT coding discussion for remote patient monitoring.
-
Coding and Coverage Overview: Remote Patient Monitoring (99091)
High-level overview of the topic, including the relationship between CMS payment policy and CPT guidance for a remote monitoring service.
-
Background
Historical context for the service, including how the code developed and how its payment treatment evolved over time.
-
Code Design
Discussion of the service concept and the kinds of work associated with the reported monitoring activity.
-
Payment
Summary of how payment has been addressed by CMS and the broader reimbursement context for the service.
-
Key Elements for Reporting
General CMS coverage considerations and CPT reporting guidance for the service, including timing, prerequisites, and relationship to other monitoring services.
-
Prior to initiation of service
Pre-service coverage and documentation considerations that apply before the monitoring service begins.
-
After initiation of service
General reporting frequency and time-based considerations that apply once the service is underway.
-
Billed with other services
How the service relates to other monitoring and care management services and examples of overlapping service categories.
-
Clinical Example (99091)
A representative clinical scenario illustrating the type of monitoring situation discussed in the article, along with its procedural description.
-
Coding Tip
A brief note highlighting a related remote monitoring coding topic and a comparison point with another monitoring service.
-
Description of Service (99091)
A concise service summary describing the general activities performed for the reported monitoring service.
What You Will Learn
- How the article frames Medicare and CPT coverage considerations for remote patient monitoring.
- What general background the article provides about the service and its payment history.
- Which broad reporting considerations are discussed for initiation, timing, and overlapping care services.
- How the article situates remote monitoring within related monitoring and care management topics.
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance professionals
- Physicians and qualified health care professionals
- Practice managers
Codes Discussed
Code Ranges Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com
