Thursday, January 12, 2023

MACs with CACs: MACs Announce Conference on Remote Therapeutic Monitoring

Over the last several years, AMA CPT has created code sets for remote physiologic monitoring and remote therapeutic monitoring (RPM, RTM), and priced them through the RVU process.  As of 2021 data, usage in Medicare was still relatively low.  

Along the way, the code sets have raised various minor policy dilemmas for CMS, discussed annually in Physician Fee Schedule rulemaking.  

If you google RTM or RPM, you quickly get sponsored ads for companies that will facilitate physician equipment and billing for these codes.  Spotchecking the Medicare Coverage Database, I didn't see any coverage policies or restrictions on these codes (no LCDs), so they seem to have reached the $100M spending mark in 2021 (see bottom of blog) without any local coverage rules.

Medicare Meeting Coming in February

There will be a joint multi-MAC Contractor Advisory Committee 

on the topic of RPM and RTM on February 28, 2023, at 6-8pm ET.

Find the Novitas website here:

Find the Palmetto website here:

The MACs state that more information (agendas, reading lists, key questions), will be available by February 14, 2022.  The structure usually opens with presentations by a few experts.  Then there isQ&A facilitated by a Medicare medical director, addressing the invited advisory physicians panel.   Normally, there is zero public participation although the meeting will be live streamed.   

The website remarks,

  • The purpose of the meeting is to obtain advice from a select panel regarding the strength of published evidence on remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices and any compelling clinical data to assist in defining meaningful and measurable patient outcomes (e.g., decreases in emergency room visits and hospitalizations) for our Medicare beneficiaries. 
  • In addition to discussion, the panelists will opine on pre-distributed questions during the meeting. CAC panels do not make coverage determinations, but MACs benefit from their advice.

After these meetings, MACs eventually post transcripts.   LCD's may be created, typically at a 6 month lag.

2021 Data

The company DATOS HEALTH has a website  about RPM and RTM services, with a table that lists the payable RPM codes as 99453, 99454, 99457, 99458, plus 99091; and the RTM codes as 98975, 76, 77, and 80, 81.

In 2021, allowed dollars for 99453 were $2.4M, for 99454 $62M, for 99457 $48M, for 99458, $17M.  For 99091, $3M.  At around $120M, that is circa $3 total per each of 40M Medicare beneficiaries.  

While these codes reached the $100M-plus annual payment level with no published policies, oddly, the CGS MAC just finalized an LCD - L34541 - on transtelephonic spirometry is covered in lung transplant patients, which is inexpensive monthly service (circa $50) in a tiny Medicare population.  There are 2000 lung transplants in the US per year, of which only part will be Medicare patients.  BTW, an online article discusses transplantation costs, from $400K pancreas to $1.6M heart.

A UC startup spinout Wellcent plans to help patients and physicians use monitoring devices in homes - here.