More Income for You, as New Codes Cover Video Patient Visits, Virtual Check-in, Remote Monitoring

Betsy Nicoletti, MS

Disclosures

February 18, 2019

In This Article

Using the Right 'Device' for Telehealth Services

Practices will need to invest in the equipment, set up, and staff to perform these services. Two of the CPT codes have no work RVUs, because they represent supplying the device and monitoring, and the set-up and education. In order to bill these codes, the device being used to monitor the physiologic data must be "a medical device as defined by the U.S. Food and Drug Administration (FDA), and the service must be ordered by a physician or other qualified health care professional."[1]

You may not use these codes if a more specific code exists to define the monitoring, such as 95250 for continuous glucose monitoring, or 93227 or 93272 for cardiographic services. These codes are described in a new subsection to the CPT book.

What is a device as defined by the FDA? This is not the same terminology as "FDA-approved." A Forbes article[2] stated that the Apple Watch 4 was considered a medical device by the FDA and also cited other devices: "Some other FDA-cleared consumer ECG devices available include AliveCor's KardiaBand and KardiaMobile that work with an Apple Watch or a smartphone/tablet (Android or iOS), respectively, and QardioCore (only outside of the U.S.) which does continuous ECG monitoring."

Using CPT Codes 99453 and 99454

Codes 99453 and 99454 are related and specific to physiologic monitoring services, such as weight, blood pressure, and pulse oximetry.

99453 is used to report the initial set-up and patient education, specifically on the use of the device. This code is reported once for each episode of care. 99454 is for providing the device and for daily recordings or programmed alert transmissions for a 30-day period. Both codes may only be reported if the monitoring is 16 days or more. It must be a medical device as defined by the FDA, and the service must be ordered by a physician, nurse practitioner, or physician assistant. These codes are not for the treatment or management of the condition. They are for providing the device and monitoring the data obtained.

  • 99453 is for setting up, educating, and monitoring a remote device that collects physiologic data; and

  • 99454 is for providing the device itself, and receiving either daily recordings or programmed alert transmissions.

The clinical example from CPT Changes 2019: An Insider's View for these codes describes a 75-year-old woman with a chronic condition who, after a visit with her primary care clinician, is enrolled in a remote physiologic patient monitoring program (99453) and the data are collected and monitored by her clinician.[3]

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