Thursday, December 11, 2014

HealthKit: Can you bill for it?

I had the opportunity to answer questions at the standing-room-only HealthKit 'Open Mic' session at the mHealth Summit 2014 this week in Washington DC (read some of my comments here and another reaction here), and one of the most frequent comments I've received since the session relates to CPT codes used for remote monitoring.

Apparently, most people don't know about CPT codes 99490, 99090 and 99091.  I didn't even know about them until recently.

But first, a disclaimer: I'm not a coding expert, and the application and reimbursement of these codes can vary by state, so please consult with your healthcare institution for details regarding how these might be used at your facility.

To review, there are two codes currently available that allow for collecting and reviewing patient data: 99090 for analysis of clinical data stored in computers and 99091 for collection and interpretation of physiologic data, with a monthly unadjusted, non-facility fee of $56.92.  The catch is that CMS has required that these codes be used in conjunction with a standard E&M service code (99201-99499), which up until now has meant an in-person office visit.

The big deal announced last month was code 99490, which is new as part of the CMS Final Rule for 2015, and will be available starting in January 2015.  This is an E&M code that can be used for remote chronic care management with a monthly unadjusted non-facility fee of $42.60.  Unlike the other E&M codes, this code does not require the patient to be present.  Thus, for the first time, this code could potentially be combined with codes 99090 or 99091 for total monthly unadjusted non-facility fee of $99.52.

While promising, no one has actually billed for this combination, yet, so it's to be determined how it will work in practice and whether other payors will get on board.  Ultimately, from my perspective as a clinician, it has the potential to allow us to care for patients with chronic disease without the inconvenience, higher-cost, or infection risk of a standard clinic visit.  That's the future, folks.

So to answer the titular question, we're getting very close to the point where we'll be able to bill for patient-generated data collected via technologies like Apple's HealthKit.  The proof is in the pudding, so to speak, and the pudding may be ready as soon as next month.

Is it any wonder why I feel technologies like Apple's HealthKit are taking us back to the future?

Additional reading:

1 comment:

  1. Thank you for this clarification. Do you suspect that HealthKit and other mobile technologies will require additional certification for reimbursement?


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