New Payment Codes: A Boon for Telehealth and Remote Monitoring and a Potential for Canada Healthcare to follow

The $3.5 Trillion Dollar Annual Healthcare spend in the US is growing leaps and bounds at 4-6% annually especially for the senior population as 10,000 individuals turn 65 years every day. There is a major need to control these costs.

In November 2019, CMS in US (Medicare/Medicaid) declared its intention to modernize the Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) for 2020, eliminating the strive to switchover from fee-for-service (FFS) to value-based care.

The new CPT® codes enable reimbursement for various providers that support in maintaining health service standards and in keeping patients away from hospitals, paving a pathway for contemporary revenue streams especially for a startup like LocateMotion.

In the past, cost compensation had often been curbed by type and geography, making it complex and strenuous to comprehend. Now, let’s take a deeper dive into the changes that have taken effect for the betterment of telehealth and remote patient monitoring (RPM), post-January 1, 2020.

Remote Physiologic Monitoring Codes

On January 1, 2019, three fresh codes took effect, that can be leveraged to enhance patient care and monetary value.

·     Code 99453 conceals setting-up of devices and educating patients to aptly use them. In 2019, CMS paid $19.46 per instance when compared to $18.77 for 2020.

·     Code 99454 encompasses the devices used for monitoring and transmitting the data to the contact centers. All the devices must be independently coded. It drops the cost from $64.15 last year to $62.07 from this year on.

·     Code 99457 covers the actual RPM and treatment management services for the 1st 20 minutes each month that the clinical staff, the physician and other qualified healthcare professionals dedicated to communicate the service details of the RPM program to the patient or caregiver. In 2019, the cost for non-facility and facility-based contracts were $51.54 and $32.44 respectively. However, the prices for 2020 have been accommodated to $51.61 and $32.84.

In certain situations, where the patient needs additional care from their healthcare professionals, CMS has decided to pay $36.09 for CPT code 99458 on January 1, 2020, covering the supplementary 20 minutes every month on treatment management services by non-clinical staff and around $27.07 otherwise. However, the challenge is in being mindful of billing against the code 99457 for the first 20 minutes and not declaring these codes for less than 20 minutes.

Codes 99457 and 99458 enable for general supervision of the billing provider in 2020, whereas in the past, direct supervision requirement had been a norm. This means that the location of the patient need not be the same, as of their healthcare professional or the clinical staff, when acquiring their treatment management services. Additionally, it induces value for greater economies of scale, by unrestricting patients irrespective of their location physically.

Transitional Care Management Codes

Codes 99459 and 99496 are used to cover transitional care management services (TCM), for existing patients who are relocating from their inpatient hospital setting to a more familiar setting, post-treatment. It is instigated once the patient is discharged, upto a period of 29 days.

·     Code 99459 supports the need of the moderately complex patient within 2 days of being acquitted from the hospital, and face-to-face visit until the next two weeks from the same date. The billing rate in 2020 is at a cost of $175.6 and $119.02 for non-facility and facility-based services respectively.

·     Code 99496 lures highly complex patients within 2 days of release, with in-person visits within a week of discharge. The charge for non-facility in 2019 was $234.97 and for facility-based it was about 112.08. In 2020, this has been improvised to a fee of $237.11 and $171.04 respectively.

As remuneration for newer types of telehealth and RPM increases, doctors can procreate additional economical value by assimilating these solutions, improving patient engagement and gratification for their obtained services.

How can SenSights.AI by LocateMotion help CMS and OHTs in the near future

· LocateMotion’s SenSights.AI Platform.

o The main purpose of the platform is focused on helping seniors age in place, reduce re-admission/admission to hospitals, provide virtual care by creating a health intelligence platform and creating a “digital twin” for the patient and finally predict chronic events like falls, wandering, strokes etc., in future.

· SenSight.AI is an innovative platform in connected healthcare delivery solutions.

o The company’s mobile, cloud-based platform powers holistic remote care management through personalized care plans, activity, and biometric data monitoring, multi-channel patient education and functionality configured to each patient’s unique needs. It empowers clinicians to proactively manage the complexities of remote care and catalyzing employee health and productivity with a single-platform solution for all devices and digital health data. The device-agnostic, comprehensive, insights rich platform and turnkey workflow services enable providers to intuitively scale and maximize value across the senior & patient population.

· Here is a quick summary of our recent solution mentions in US & Canadian news.

Please contact me at for further details and a potential demo of the innovative solution.