CPT-99091

CPT code 99091 Introduction

CPT 99091 covers the standalone collection and interpretation of remote data. It includes half-hour of RPM clinical time between a patient and a physician per month, and also requires a minimum of one instance of communication, which may be a call, video visit or perhaps email exchange.

CODE DESCRIPTION

CPT 99091 describes the collection and interpretation of physiologic data (e.g., ECG, pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional.

For Code 99091, the initial provider service must occur within the physician’s office or other applicable sites. Additionally, only a physician or QHP may perform these services, distinguishing it significantly from Code 99457 during which a clinical staffer can provide services “incident to.”

Notably, the info from devices employed in conjunction with code 99091 don’t must be from a tool as defined by the FDA. There’s no set number of conditions that has to be monitored to satisfy criteria associated with CPT Code 99091.

CODING CRITERIA

• For CPT 99091 30 minutes of services furnished over a 30-day period must be documented.
• While a provider isn’t required to submit a claim for CPT 99453 and 99454 to bill for CPT 99091, it appears CMS requires such data analysis and interpretation to be supported a minimum of 16 days of information.
• A practitioner who bills for CPT 99091 without having billed for CPT 99453 and 99454 still would be subject to the established patient and consent requirements.
• For the duration of the COVID-19 PHE, only 2 days of monitoring is required for patients with suspected or confirmed cases of COVID-19 to bill for this code.
• Providers may use this code during the same service period as Chronic Care Management (CCM) (99487-99490), Transitional Care Management (TCM) (99495-99496), and Behavioral Health Integration (BHI) (99484, 99492-99494).

BILLING CRITERIA

• CPT 99091 can only be billed by a physician or qualified professional (QHP) and not by general clinical staff.
• This code cannot be billed in conjunction with 99457, and is meant for stand-alone treatment.
• Practitioner should obtain beneficiary consent before initiating RPM services and document this consent within the beneficiary’s medical history.

REIMBURSEMENT CRITERIA

On average, CPT code 99091 permits for a reimbursement of $56.41.