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Examples of the reimbursable codes can be found below *

Remote Physiologic Monitoring

Code: 99453

Remote monitoring of physiologic parameter(s) (e.g. pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment

Code: 99454

Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

Code: 99457

Covers the initial time spent by the physician or qualified clinician in actual treatment of the patient's condition. Like the data collected, this can be also administered remotely, including a telephone or video connection

Code: 99458

Enables practices to support remote patients with extra care and additional services while billing for these services in 20-minute increments. Allows reimbursement for a qualified healthcare professional's time monitoring data and engaging with patients during a 30-day period.

Pulmonary Testing and Therapies

Code: 94014

Spirometry, Home, Patient Recorded, with Interpretation per 30 days of home measurements. Includes physician interpretation of results. Can be performed with transmission of data to the caregiver. PEF and FEV1 values are satisfactory for reimbursement.

Code: 94015

Spirometry, Home, Patient Recorded per 30 days of home measurements. Does not include physician interpretation of results. Can be performed with transmission of data to the caregiver.

Code: 94016

Spirometry, Home, Patient Recorded, Physician Interpretation Only per 30 days of home measurements for only the physician interpretation of results. Can be performed with transmission of data to caregiver. Does not require graphic record or full flow/volume detail. PEF and FEV1 values are satisfactory for reimbursement.

Remote Therapeutic Management

Code: 98975

Initial set-up and patient education on use of equipment. CPT Code is a one-time billable code for the initial set-up and patient education on the use of the equipment.

Code: 98976

Supply of RTM device(s) with scheduled recording and/or programmed alert transmission to monitor musculoskeletal system for each 30 day period. ( Respiratory)

Code: 98980

Remote therapeutic monitoring treatment management services, physician/ other. qualified health care professional time in a calendar month requiring at least one interactive. communication with the patient/caregiver during the calendar month; first 20 minutes.

Code: 98981

Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)

Resources:

1. Centers for Medicare & Medicaid Services, Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2020, with Comment Period Date as 2019-12-31 and Publication Date as 2019-11-15. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F.

2. AMA:Resources to help accurately bill procedures and services. https://www.ama-assn.org/practice-management/cpt/finding-coding-resources

3. 2020 AMA CPT (Current Procedural Terminology) Professional Edition, CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. *

Disclaimer:

The reimbursement information is being provided on an “as is” basis with no express or implied warranty of any kind and should be used solely for your internal informational purposes only. The information does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. Keva Health does not represent or warrant that any of the information being provided is true or correct and you agree to hold  Keva Health harmless in the event of any loss, damage, liabilities or claims arising from the use of the reimbursement information provided to you. Before filing any claims, it is the provider’s sole responsibility to verify current requirements and coverage policies with the applicable payer.

*CPT © Copyright 2020 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.

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