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New Reimbursement Rules Give RPM Providers a Much-Needed Win

Analysis  |  By Eric Wicklund  
   October 30, 2024

The decision from the AMA’s CPT panel will help health systems and hospitals scale and sustain smaller and more inclusive RPM programs.

(Editor's note: This article was corrected to note that the change will go into effect in 2026, not 2025)

A key deterrent to the development of remote patient monitoring programs is being removed, giving healthcare organizations a better opportunity to scale and sustain those services.

The American Medical Association’s CPT Editorial Panel has removed a requirement that RPM providers collect data on at least 16 of 30 days to qualify for Medicare reimbursement, opening the door to short-term and less frequent programs and coverage for a wider range of patients. The change is slated to go into effect at the beginning of 2026.

The panel’s decision, made during its September meeting, is a pleasant surprise for telehealth and RPM advocates, who had supported a proposal in May to create new “supply of device” codes that would have allowed providers to be reimbursed for less than 16 days in a 30-day period.

“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.

The panel declined to support the proposal at its May meeting, leading to concerns that it wouldn’t be brought up again until next year. How or why the panel changed its mind at the September meeting isn’t clear, though it should be noted the change won't take place until the beginning of 2026.

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.

The ruling is a bit of good news at a time when good news has been hard to find. Just last month, the HHS’ Office of the Inspector General (OIG) issued a report over the possibility of fraud in requests for Medicare reimbursement in RPM programs. The report prompted an angry response from the Alliance for Connected Care, which called it inaccurate.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.


KEY TAKEAWAYS

CMS has reimbursed for remote patient monitoring programs since 2019, though coverage is limited.

Healthcare providers have lobbied to increase CPT codes for RPM reimbursement, as well as for less restrictive rules that limit how, when and where they can collect data.

A recent decision from the AMA’s CPT panel eliminates the need for providers to collect data from RPM devices at least 16 of every 30 days.


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