Charting Change: CPT Coding and Remote Monitoring

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Summary

The AMA’s upcoming CPT Editorial Panel meeting on coding and billing for remote monitoring will shape the future of digital health technology.

The American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel creates, revises, and updates codes, descriptions, and applicable guidelines for CPT coding. The panel is comprised of 21 members appointed by the AMA Board of Trustees and receives assistance from a larger body of CPT advisors, the CPT Advisory Committee.

The CPT Editorial Panel meets thrice yearly and will hold its first meeting of 2024 on February 1–3. Members will discuss remote monitoring (among other topics), which will have implications for future coding and billing of products, services, and tools used alongside this technology.

Increasing Prominence of Remote Monitoring

Remote monitoring refers to the use of technologies to monitor patients remotely. It involves observing or tracking the performance, status, or data of a system, device, or process from a remote location, made possible by technology and communication tools. Remote monitoring includes Remote Physiologic Monitoring (RPM) and the more recently developed Remote Therapeutic Monitoring (RTM). In recent years, digital health and remote monitoring have gained increased recognition from lawmakers and regulators. For example, the Coronavirus Preparedness and Response Supplemental Appropriations Act (2020) added flexibility in digital health coverage that encouraged uptake of digital health tools such as RPM and RTM.

RTM is a set of CPT codes intended to track patient utilization of medical devices and collect non-physiological data. RTM can help monitor adherence, symptom management, and more through patient-reported data. In contrast, RPM involves collecting, transmitting, evaluating, and communicating patients’ physiologic health data from electronic devices such as handheld medical equipment, implanted equipment, and wearable sensors.

Utilization of both types of remote monitoring increased during the COVID-19 pandemic, leading the Centers for Medicare and Medicaid Services (CMS) to expand coverage, coding, and reimbursement for RTM and RPM. The Consolidated Appropriations Act of 2023 extended these COVID-19 digital health flexibilities through the end of 2024. Stakeholders should continue to monitor whether Congress seeks to extend these flexibilities beyond 2024 and, if so, how these services will be funded in the future.

Tracking the Future of Digital Health Tools

Looking ahead, CMS and the AMA are evaluating the continuation of COVID-era digital health policies post-pandemic. The upcoming CPT Editorial Panel meeting is crucial for addressing key concerns surrounding the billing and coding of these tools. Stakeholders should monitor these meetings as they navigate the evolving landscape of remote monitoring’s impact on CPT coding and billing practices.

Avalere experts are leveraging cutting-edge insights and strategic expertise to help clients implement effective remote monitoring solutions, ensure improved patient outcomes, and operational expertise. To speak with digital health and coding subject matter experts, connect with us and look out for our upcoming Avalere’s Take on this meeting, which can be accessed through Federal Policy 360.

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