When it comes to Remote Patient Monitoring (RPM), understanding the intricacies of billing and reimbursement is essential for healthcare professionals. One of the critical billing codes associated with RPM is CPT Code 99091.
This article will explore the billing process for CPT Code 99091, how it fits into the broader context of remote monitoring programs, and what it means for healthcare providers working with solutions like those offered by DrKumo.
What is CPT Code 99091?
CPT Code 99091 refers to the “collection and interpretation of physiologic data” such as ECG, blood pressure, and glucose levels. This data is “digitally stored and/or transmitted by the patient” and is analyzed by a physician or qualified healthcare professional. A key requirement for billing under this code is that the healthcare professional spends “a minimum of 30 minutes of time, every 30 days” reviewing and interpreting the patient’s data.
As outlined in the CY 2018 Physician Fee Schedule (PFS) final rule, the valuation of CPT Code 99091 includes 40 minutes of total work time. This breakdown includes:
- 5 minutes of preservice work (e.g., chart review)
- 30 minutes of intra-service work (e.g., data analysis and interpretation, report generation, patient communication)
- 5 minutes of post-service work (e.g., documentation)
This structure ensures that professionals are compensated for their expertise in reviewing and interpreting patient-generated health data.
How CPT Code 99091 Works with DrKumo’s RPM Solutions
CPT Code 99091 is a vital component of any RPM program, including those offered by DrKumo. DrKumo’s state-of-the-art platform allows healthcare providers to monitor their patients’ physiologic data in real time, using advanced digital health tools and AI-driven analytics. DrKumo supports a wide range of medical devices, including Blood Pressure Monitors, Glucometers, Pulse Oximeters, and more, providing real-time data that can be analyzed to help prevent complications in patients with chronic conditions.
Once the physiologic data is collected through DrKumo’s Remote Patient Monitoring system, providers can utilize CPT Code 99091 to bill for the time spent reviewing, analyzing, and interpreting the data. This code is essential for healthcare professionals who leverage DrKumo’s technology to track vital signs like blood pressure, glucose levels, heart rate, and more.
By ensuring compliance with Medicare guidelines, DrKumo’s platform makes it easier for healthcare providers to document and submit claims for CPT Code 99091, streamlining the billing and reimbursement process.
Who Can Bill for CPT Code 99091?
There has been some confusion about who qualifies to bill for CPT Code 99091. According to CMS PFS (2021), this service must be provided by a physician or other qualified healthcare professional, defined as:
“An individual who is qualified by education, training, licensure/regulation (when applicable) and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.”
This means that clinical staff who assist in the performance of RPM services cannot independently bill for CPT Code 99091. Only healthcare professionals authorized by Medicare to independently bill for services within their scope of practice are eligible to submit claims under this code.
Proper Billing and Documentation
Accurate documentation is key to successful reimbursement under CPT Code 99091. To avoid denials, healthcare providers using DrKumo’s RPM platform should:
- Document Time Spent: The healthcare professional must document at least 30 minutes of intra-service work within a 30-day period, which includes activities like data review, analysis, and patient communication.
- Obtain Patient Consent: Ensure patient consent is obtained before starting remote monitoring services. This consent should be recorded in the patient’s file.
- Use Correct Modifiers: Depending on the scenario, modifiers like 95 for telehealth services may need to be included in the billing code to ensure proper reimbursement.
Reimbursement and Compliance Considerations
Medicare reimburses CPT Code 99091 under specific conditions, ensuring that healthcare providers are compensated for their time and expertise. According to CMS:
“Medicare also covers and makes payment for certain services performed by auxiliary personnel (which includes clinical staff) ‘incident to’ the professional services of the billing practitioner.”
This means that while clinical staff can assist in RPM services, the ultimate responsibility and billing rights lie with the physician or other qualified healthcare professional.
Takeaways
Billing for CPT Code 99091 is critical for healthcare providers offering remote patient monitoring services. With platforms like DrKumo, which deliver real-time health data streaming and advanced AI/ML analytics, providers can seamlessly monitor and manage their patients’ chronic conditions while ensuring compliance with Medicare’s billing guidelines.
By ensuring that the appropriate professional provides the service, thoroughly documenting time spent on data analysis, and meeting all other billing requirements, healthcare providers can maximize reimbursement while delivering high-quality care to their patients.
To learn more about how DrKumo can help you streamline your remote patient monitoring services and ensure compliance with CPT Code 99091, contact us today or visit our website.
Disclaimer: The information provided in this blog is for informational purposes only and is not intended as legal or medical advice. Please consult with a qualified healthcare professional or billing expert for specific guidance on your practice’s reimbursement process.
