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Has Remote Patient Monitoring Hit a Roadblock?

Analysis  |  By Eric Wicklund  
   May 21, 2024

The AMA's CPT Editorial Board has hit a stalemate over proposed changes that would boost reimbursement for RPM, so what does it mean for its future?

A push to improve reimbursement for Remote Patient Monitoring (RPM) programs has stalled, and that could prompt health systems and hospitals to think twice about launching or expanding their platforms.

According to social media and news reports, the roadblock is coming from the American Medical Association’s 21-member CPT Editorial Panel, which hasn’t been able to agree on amendments to the CPT codes covering RPM services. The panel indefinitely suspended the proposed changes at its May meeting.

RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services (CMS) through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting. CMS has slowly amended and expanded those codes since then, adding codes for remote therapeutic monitoring.

Advocates have long argued that the codes are too restrictive on everything from what devices can be used to what conditions are covered to what data can be gathered. In all, providers can only expect to receive about $170 in Medicare reimbursements per patient per month.

At issue is the requirement that a healthcare provider collect at least 16 days of RPM data from a patient over a 30-day period to bill for Medicare reimbursement through CMS Providers and RPM advocates have long argued that the threshold is too high, that some programs don’t need 16 days of data, and that the reimbursement doesn’t cover the time and effort put into collecting the data. But a proposal before the CPT committee to create new “supply of device” codes that would have allowed providers to be reimbursed for less than 16 days of data over a 30-day period didn’t get the support to move forward.

“Since separate payments for [RPM] services were established, industry stakeholders have advocated against this 16-day requirement arguing that it is clinically arbitrary and ignores conditions where a reduced number of days would be more clinically appropriate,” Thomas Ferrante and Rachel Goodman, partners in Foley & Lardner’s Telemedicine & Digital Health Industry Team, said in a 2023 blog.

During the COVID-19 Public Health Emergency, CMS relaxed the rules, dropping the RPM threshold to two days instead of 16. But when the PHE officially ended on May 11, 2023, the 16-day threshold was returned. A bill initially introduced in 2021 and resubmitted each year by U.S. Reps. Katie Porter of California and Troy Balderson of Ohio has sought to extend that relaxed threshold for two years and prompt the U.S. Health and Human Services Department to study a long-term solution, but the bill hasn’t made it out of committee.

The issue has hampered the development of new RPM programs, as health systems and hospitals often rely on Medicare reimbursement to sustain those programs. Without that financial support, some organizations may decide against launching or expanding their platforms.

The AMA’s CPT Editorial Panel next meets on September 19-21. Whether any changes to RPM codes are on that agenda remains to be seen.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


KEY TAKEAWAYS

Health systems and hospitals are embracing remote patient monitoring (RPM) as an effective strategy to extend care management outside the hospital, doctor’s office, or clinic.

CMS first recognized RPM in 2019 with a few CPT codes aimed at enabling clinicians to be reimbursed for remotely collecting patient data.

With proposed amendments to those CPT codes that would have improved reimbursement shelved for now, healthcare executives may think twice about launching or expanding their RPM programs.


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