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Medi-Cal Rates Update 2022: California RPM Reimbursement Guide for Providers

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Rates for Medi-Cal are updated and effective as of the March 15, 2022, and are published on the Medi-Cal website on the 16th.
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The Department of Health Care Services (DHCS) views telehealth as a cost-effective alternative to in-person health care, particularly in underserved areas. Remote patient monitoring is assisting in the transition from episodic, reactive care delivered in clinical settings to a continuous, proactive model that integrates virtual and in-clinic treatment as health care shifts from a fee-for-service to a value-based approach that rewards performance and outcomes.

Every year, CMS releases new Medicare Physician Fee Schedule[1] that outlines billable activities as well as reimbursement criteria for the coming year. CPT codes and criteria for RPM services can be found in this publication once a year.

RPM services rendered to established patients are reimbursed under CPT codes 99091, 99453, 99454, 99457, and 99458. To guide California healthcare providers in RPM billing and reimbursement, here are the Medi-Cal rates[2] that have been updated and are effective as of March 15, 2022:

5 relevant CPT Codes

CPT codes with basic rate

For the complete list of rates, click here.

Takeaway

Chronic illness treatment and prevention are threatening to overrun California’s healthcare safety net, which includes provider and payer organizations that help low-income people. The safety net, which has long been strained by labor shortages, is now being strained even more by the rising frequency of chronic diseases such as heart disease and diabetes among the patient population. Medical practices that embrace RPM technologies today will be in a better position as health outcomes and performance are incentivized.

To know more about the CPT Codes for Remote Patient Monitoring, click here.

References:

  1. “Physician Fee Schedule | CMS.” Physician Fee Schedule | CMS, www.cms.gov, 9 Mar. 2022, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched.
  2. “Medi-Cal: Medi-Cal Rates Information.” Medi-Cal: Medi-Cal Rates Information, files.medi-cal.ca.gov, https://files.medi-cal.ca.gov/Rates/rates_information.aspx?num=22&first=94799&last=99600. Accessed 9 Apr. 2022.

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