Care Management by Clinical Staff: After analyzing and interpreting remotely collected physiologic data, the data is used to develop a treatment plan and then manage the plan until the targeted goals of the treatment plan are attained. CPT codes 99457 & 99458 are designated as care management services and as such can be provided by clinical staff under the general supervision of the physician or NPP. Interactive Communication: Services are typically provided remotely using communications technologies that allow interactive communication.
Interactive communication, involves, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission; as well as, time engaged in non-face-to-face care management services during a calendar year. The first 20 minutes of interactive communication is reporting using CPT 99457 and each additional 20 minutes is reported using CPT code 99458.
RPM During The Public Health Emergency
CMS made temporary modifications to RPM requirements to enable individuals to receive care virtually during the PHE. These changes include the following:
- New patients can receive RPM services without an in-person visit.
- Those who have contracted with a billing physician or practitioner to provide RPM services may obtain consent directly from individuals receiving care. Consent can also be obtained at the time services are provided.
- Monitoring days have been decreased from 16 to 2 allowing individuals who would benefit from shorter periods of monitoring to receive care.
In many cases, short-term monitoring that traditionally occurs in-person can be provided virtually. When the PHE ends, RPM services will, once again, only be provided to established patients. This is to ensure that physicians or practitioners have a pre-existing relationship and the opportunity to collect patient history and conduct a physical examination, as appropriate, prior to rendering RPM services.
In addition, those contracting with physicians to provide RPM services will no longer be able to obtain consent directly from the individual and days of required monitoring will also return to 16-days. CMS however will continue its policy to allow consent for RPM services to be obtained at the time services are furnished on a permanent basis.
Billing Codes
First 20 Minutes Of Communication
99457
Each Additional 20 Minutes of Communication
99458