Digital health is transforming healthcare delivery, and with it comes new potential revenue. For doctors and healthcare providers venturing into the digital realm, understanding the most relevant Current Procedural Terminology (CPT) codes is crucial for maximizing revenue and ensuring proper reimbursement.
This article delves into the top CPT codes used in digital health, empowering you to navigate the evolving landscape and optimize your practice’s financial health.
A Spectrum of Services: Key CPT Codes and Revenue Potential
Digital health encompasses a wide range of services, each with its own set of applicable CPT codes and associated revenue potential. Here’s a breakdown of some of the most commonly used codes across various areas:
- Remote Patient Monitoring (RPM): RPM allows healthcare providers to collect physiological data from patients remotely, enabling them to monitor chronic conditions and medication adherence. This data can include vital signs like blood pressure, weight, oxygen saturation, and blood sugar levels.
- CPT Code:
- 99454 (Monthly Remote Monitoring of Physiological Parameters): This core RPM code reimburses for the remote monitoring of vital signs. Reimbursement is dependent on 16 days of data collected per month.
o Additional Codes for RPM Services:
- 99457 (Remote Physiological Monitoring Treatment Management Services, First 20 Minutes): This code reimburses for the first 20 minutes of time spent by a healthcare professional on data analysis, interpretation, and communication in an RPM program each month.
- 99458 (Remote Physiological Monitoring Treatment Management Services, Each Additional 20 Minutes): This code applies for each additional 20 minutes of time spent on RPM services beyond the initial 20 minutes covered by 99457 (This can be billed multiple times in a month).
- Remote Therapeutic Monitoring (RTM): RTM involves the monitoring and collection of non-physiological data from patients using approved, connected medical devices. RTM codes are categorized as “general medicine” codes, which Dr.s, PTs, OTs, and RNs can bill for. RPM codes fall under evaluation and management (E/M) codes
- CPT Codes:
- 99457 (Remote Physiologic Monitoring Treatment Management Services): This code applies specifically to RTM services and goes beyond simple data collection. It encompasses the analysis, interpretation, and communication of the patient’s monitored data, informing treatment decisions.
o Additional Codes for RTM Services:
- 98980 (Remote Therapeutic Monitoring Treatment Management Services, First 20 Minutes): This code reimburses for the first 20 minutes of time spent by a healthcare professional on data analysis, interpretation, and communication in an RTM program each month.
- 98981 (Remote Therapeutic Monitoring Treatment Management Services, Each Additional 20 Minutes): This code applies for each additional 20 minutes of time spent on RTM services beyond the initial 20 minutes covered by 98980 (This can be billed multiple times in a month).
Revenue Potential: By implementing RPM and RTM services, healthcare providers can potentially earn recurring monthly revenue for each enrolled patient. The specific revenue depends on the number of patients, the specific CPT codes billed, and payer reimbursement rates. However, some estimates suggest that practices can generate ~$180+ per patient monthly through RPM and RTM services.
- Telehealth: Telehealth consultations allow doctors to connect with patients remotely using video conferencing or secure messaging platforms.
- CPT Codes 99202 – 99215 (Evaluation and Management Services – E/M): These codes encompass telehealth consultations with varying levels of complexity, similar to in-person visits. Reimbursement for these codes varies depending on the level of service provided, ranging from $40-$90 per encounter.
- Chronic Disease Management: Chronic disease management programs involve ongoing monitoring and care coordination for patients with chronic conditions.
- CPT Codes 99490-99492 (Chronic Care Management Services): These codes encompass various chronic disease management services, with reimbursement varying based on complexity of the care plan and time spent. Reimbursement typically ranges from $40-$80 per month.
Optimizing Your Digital Health Revenue Cycle
While the potential revenue from digital health services is significant, here are some tips for maximizing your return:
- Invest in a user-friendly platform: A platform like Actuvi that integrates with your billing system can streamline coding and claims submission for all your digital health services.
- Develop a clear documentation strategy: Accurate documentation, especially for RTM services involving data analysis and treatment management, is essential for supporting claims and ensuring proper reimbursement.
- Stay informed on reimbursement updates: Regularly check with payers and healthcare IT resources for changes in CPT code definitions and reimbursement rates for various digital health services.
The Future of Digital Health Billing
As digital health continues to evolve, so too will the CPT coding system. By staying informed and adopting sound billing practices, healthcare providers can navigate this evolving landscape and unlock the full revenue potential of their digital health services. Remember, this is not an exhaustive list, and new codes are introduced regularly. Reach out to Actuvi to learn how we can help you set up these programs in your practice and give you the technology to succeed.
