Physician Fee Schedule Update 2021

The 2021 Physician Fee Schedule was released on Monday, December 1st.

Below are a few key takeaways regarding the RPM changes included in the new 2021 Physician Fee Schedule. 

1) CMS cleared the air on RPM payment policies related to CPT codes 99453, 99454, 99091, 99457, and 99458.

2) Relating to codes 99453 and 99454 (Equipment Set-Up & Training), auxiliary personnel (i.e. contracted employees) may provide services that are incident to the physician’s billing services while under their supervision.

3) Once the pandemic ends, the requirement of 16 out of  30 days of remote monitoring must have data captured and transmitted to submit claims for CPT codes 99453 and 99454.

4) Relating to codes 99457 and 99458, CMS has clarified that interactive communication is defined as a conversation occurring in real-time via synchronous, two-way interactions using video and/or audio.

5) Medical devices are required to be valid, reliable, and able to transmit data electronically and automatically, rather than the patient having to self-report.  Check Section 201 of the Food, Drug, and Cosmetic Act for more details.

Based on this new information, it is very clear that remote care and telehealth are here to stay.

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