The American Medical Association’s coding panel, which is responsible for creating medical billing codes, is set to meet September 19-21 in Albuquerque where it will consider yet another proposal to lower the requirements for providers to get paid for remote monitoring.
Remote monitoring was scarcely mentioned in the Center for Medicare and Medicaid Services’ (CMS) proposed CY2025 physician fee schedule, out last week, which dashed any hope for payment changes by 2025. A source said it wasn’t surprising that CMS left out remote monitoring code changes, as the agency had not received a code change recommendation by the AMA.
CMS can create some codes without an AMA recommendation, another source said, like the new G codes it proposed in the physician pay rule for “digital mental health treatment devices,” like digital therapeutics. Experts are skeptical that the G codes, which are cross-walked to remote therapeutic monitoring codes, would change anything about payment for the software-delivered therapy.
If the latest remote monitoring code change application goes through at the September coding meeting, the earliest the industry could see significant remote monitoring changes is in 2026, barring legislation.
The code change application submitted to the AMA’s Current Procedural Terminology Editorial panel includes paying providers for less calendar days of data collection (down from 16 days) and paying providers for 10 minutes of treatment management services (down from 20 minutes) for both remote physiologic monitoring and remote therapeutic monitoring, according to the public agenda.
The proposal also includes revising nine existing remote monitoring codes.
A remote monitoring code change application successfully made it into the May coding panel meeting and was discussed by the panel. Sources said at the time that the talks were going well until the panel fell into disagreement. One source called the discussion “tense.”
The panel decided to indefinitely postpone talks of the code changes. One source involved in the meeting said they hoped the panel will re-up the discussion in its September meeting, but another involved party considered it “dead.”
Here’s the newest proposal:
Remote Therapeutic Monitoring:
- Revise RTM services guidelines and treatment management services guidelines
- Add RTM supply codes for respiratory, musculoskeletal and cognitive behavioral therapy (98XX4, 98XX5, 98XX6) for 2-15 calendar days.
- Add RTM treatment management services code 98XX7 to include 10 minutes of service
Remote Physiologic Monitoring:
- Add supply code 99XX4 for 2-15 calendar days of data collection for RPM
- Add code 99XX5 for 10 minutes of RPM treatment management services
- Revise the Digitally Stored Data Service/Remote Physiologic Monitoring guidelines and revise RPM treatment management services guidelines
If the code change application makes it into the September meeting without last-minute revocation, and the panel moves it forward, it would be sent to the AMA’s code valuation committee, the RVS Update Committee (RUC).
The RUC typically meets in February to determine code valuations. It then sends its recommendations to CMS for consideration in the next year’s physician fee schedule. If this standard coding process is followed, the soonest the industry could see significant remote monitoring changes is in 2026, barring legislation.
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Originally Published On: Fierce Healthcare
Photo courtesy of: Getty Images
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