CMS Faces Calls to Improve Remote Patient Monitoring Coverage in 2022 PFS

With remote patient monitoring projects surging in popularity as a result of the pandemic, telehealth advocates are lobbying the Centers for Medicare & Medicaid Services to improve proposed coverage plans in the 2022 Physician Fee Schedule.

Among those submitting comments to CMS are the American Telemedicine Association, which says the proposed coverage is a “missed opportunity … to continue to expand access to needed care,” and Carrie Nixon of the Nixon Gwilt law firm, who is asking CMS to improve and better integrate the proposed CPT codes with codes already in place.

The issue boils down to how CMS defines remote patient monitoring – a concept it didn’t even address until 2019 – and how it proposes to reimburse providers for data collection and other activities involved in care for patients at home.

CMS initially created a handful of CPT codes for what it called “remote physiological monitoring,” and separated those services from its telehealth coverage, allowing providers some leeway to launch RPM programs that use connected health technology to monitor patients at home. Earlier this year, in its proposed 2022 PFS, the agency created a new category for “remote therapeutic monitoring,” giving providers a few new reimbursable services.

Reaction to the proposed 2022 PPF was less than enthusiastic. Nixon and Foley & Lardner attorneys Thomas Ferrante and Nathaniel Lacktman, chair of the firm’s Telemedicine & Digital Health Industry Team, said the proposed codes raised as many questions as answers, and urged stakeholders to submit comments before the September 13 deadline.

Nixon, for example, feels the RPM and RTM codes should be better aligned, so that more providers can take advantage of the coverage opportunities and they can bill for more data collected. She also feels that CMS should clarify that the proposed RTM codes don’t allow incident-to-billing of clinical staff time under the general supervision of physicians, nurse practitioners, physician assistants or QHCPs who order RTM services.

For that, she recommends creating a temporary code set for Medicine HCPCS G-codes for RTM, designating them as care management services subject to general supervision when order by a physician or NPP.

“CMS needs to develop a coding structure in alignment with RPM that allows for billing practitioners to leverage clinical staff under general supervision in the Final Rule to avoid excluding valuable use cases for RTM,” she says in a recent blog.

In addition, Nixon recommends that CMS create a temporary Medicine HCPCS G-Code for supply of system-agnostic devices for RTM, expanding proposed rules that would have limited coverage to musculoskeletal and respiratory devices and excluding technology to treat, among other things, medication adherence, pain, mood and therapy response.

And she calls on CMS to cover RTM services at the same rate as it does RPM services.

In its comments to CMS, the ATA also takes issue with the lack of integration between proposed RTM codes and RPM codes. It also recommends creating a temporary set of G-codes.

“These G-codes will allow for incident-to billing and are essential to ensuring auxiliary personnel and clinical staff are able to assist in the provision of RTM services under the general supervision of a billing provider, as correctly questioned by CMS,” the ATA writes. “In addition, CMS should ensure the RTM codes allow all relevant providers, including physical therapists and other qualified health care providers, to bill independently for RTM services. The ATA suggests creating another set of new G-codes for RTM treatment assessment services under general medicine that would allow for non-physician providers (physical therapists and nurses) to bill directly. In doing so, CMS will allow a greater array of providers to offer RTM services.”

The ATA also urges CMS to expand the types of devices that would qualify for reimbursement and to “consider broader use cases for RTM, including but not limited to behavioral and mental health therapies and services addressing vascular, endocrine, neurological and digestive systems,” ideally through the creation of a condition-agnostic supply code.

The organization offers several recommendations aimed at better aligning RTM and RPM codes, including expanding coverage of new use cases and extending regulatory flexibilities granted to RPM coverage during the COVID-19 public health emergency, including provisions related to “acute and chronic patients, obtaining consent at the time of service, general supervision, cost-sharing waivers for COVID patients, and allowing access to new and established patients.”

“Alignment of RTM and RPM must avoid misguided policies of the past, including many recurring concerns with the current RPM payment structure,” the organization states. “For example, the ATA urges CMS to not reflect RPM’s minimum-days-of-monitoring requirement in new policies for RTM. The ATA also recommends the agency’s ensuring RTM services can be used for new as well as established patients, even when the current COVID-19 PHE ends.”

“The ATA urges CMS to consider specific changes to ensure appropriate availability and usage of RPM services through the Medicare program,” the letter continues. “At a minimum, we ask that these barriers not be repeated in RTM payment policy. The ATA urges CMS to create complementary G-codes to allow for RPM treatment-assessment services, which would allow non-physician providers to permanently bill for RPM as well. These providers could include but are not limited to physical therapists and other non-physician providers, who would then be allowed to bill these codes within their benefit categories and scopes of practice.”

Finally, the ATA takes CMS to task for not updating its RPM codes in the proposed 2022 PFS, calling it a missed opportunity to further expand adoption of RPM services.

Whether CMS amends its proposed 2022 PFS to improve coverage for remote patient monitoring could affect how healthcare organizations plan their connected health strategies for the future. While not the only factor, Medicare reimbursement is a significant factor in RPM planning and development, especially by smaller hospitals, clinics and medical practices.