RPM coding and payment reforms tabled again

Earlier this month, an American Medical Association-anointed panel was set to consider proposed changes that would have simplified and broadened applicability of billing codes governing wearables and other devices doctors can use to monitor patients outside the clinic. But it didn't happen because the revisions were pulled from the agenda of CPT Editorial Panel's periodic meeting about a week before the meeting. This happened once before in September 2022.

The codes in question here surround the use of devices for remote physiologic monitoring (RPM) of measures like weight and blood pressure, and remote therapeutic monitoring (RTM), for example of medication adherence or response. CPT codes are used by doctors to bill and by Medicare and private insurers to reimburse for medical services. These codes are significant because they dictate the business models of a huge swath of companies that have cropped up to help practices and health systems provide such services — and influence whether clinicians bother to offer services to patients at all.

The most significant change would have reduced the number of days of data a clinician would have to review to be paid from 16 to as few as two. This proposal addressed concerns that the codes don't work for people who may benefit from less monitoring. The changes also would have grouped together RPM and RTM and done away with specific categories around therapeutic monitoring for musculoskeletal and respiratory conditions in favor of more general categories.

The DMPAG — a panel that advises AMA on digital matters — proposed the code changes, acknowledging that "technologies matured to the point where the RPM and RTM codes require revision and updating to represent current practice." It's unclear why the group decided to withdraw its code change application, though, at least one advocacy group representing major health systems and retailers publicly opposed the changes. It's possible more behind the scenes jockeying is at play. Perhaps there was a sense that the changes would not be approved by the Editorial Panel which consists of representatives from medical professional societies, industry groups, and insurance companies. Know something I should? Reach out: mario.aguilar@statnews.com

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