Has Remote Patient Monitoring Hit a Roadblock?

By Eric Wicklund

A push to improve reimbursement for Remote Patient Monitoring (RPM) programs has stalled, and that could prompt health systems and hospitals to think twice about launching or expanding their platforms.

According to social media and news reports, the roadblock is coming from the American Medical Association’s 21-member CPT Editorial Panel, which hasn’t been able to agree on amendments to the CPT codes covering RPM services. The panel indefinitely suspended the proposed changes at its May meeting.

RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services (CMS) through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting. CMS has slowly amended and expanded those codes since then, adding codes for remote therapeutic monitoring.

Advocates have long argued that the codes are too restrictive on everything from what devices can be used to what conditions are covered to what data can be gathered. In all, providers can only expect to receive about $170 in Medicare reimbursements per patient per month.

“Since separate payments for [RPM] services were established, industry stakeholders have advocated against this 16-day requirement arguing that it is clinically arbitrary and ignores conditions where a reduced number of days would be more clinically appropriate,” Thomas Ferrante and Rachel Goodman, partners in Foley & Lardner’s Telemedicine & Digital Health Industry Team, said in a 2023 blog.

During the COVID-19 Public Health Emergency, CMS relaxed the rules, dropping the RPM threshold to two days instead of 16. But when the PHE officially ended on May 11, 2023, the 16-day threshold was returned. A bill initially introduced in 2021 and resubmitted each year by U.S. Reps. Katie Porter of California and Troy Balderson of Ohio has sought to extend that relaxed threshold for two years and prompt the U.S. Health and Human Services Department to study a long-term solution, but the bill hasn’t made it out of committee.

The AMA’s CPT Editorial Panel next meets on September 19-21. Whether any changes to RPM codes are on that agenda remains to be seen.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.