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2021 CPT Codes by the CMS for Medicare Extension Care Management Programs

Chronic Care Management:

The chronic care management program was virtually untouched by the 2021 Final Rule from CMS. There are three main CPT codes and two add-on CPT codes in 2021 that may be billed by primary care providers for CCM services.

C

Requirements for CCM:

Non-Complex CCM:

  • Two or more chronic conditions expected to last at least 12 months (or until the death of the patient)
  • Patient consent (verbal or signed)
  • Personalized care plan in a certified EHR and a copy provided to the patient
  • 24/7 patient access to a member of the care team for urgent needs
  • Enhanced non-face-to-face communication between patient and care team
  • Management of care transitions
  • At least 20 minutes of clinical staff time per calendar month spent on non-face-to-face CCM services directed by a physician or other qualified healthcare professional
  • CCM services provided by a physician or other qualified healthcare professional are reported using CPT code 99491 and require at least 30 minutes of personal time spent in care management activities

Complex CCM:

Shares common required service elements with CCM but has different requirements for:

  • Amount of clinical staff service time provided (at least 60 minutes)
  • The complexity of medical decision-making involved (moderate to high complexity)

CPT Reimbursement Codes for CCM Service:

Non-complex CCM:

  • CPT Code 99490– This code requires that patients must have two or more chronic conditions, as well as documented consent to enroll in the program AND receive at least 20 minutes of CCM services from clinical staff within a given month. A personalized care plan, which shows an assessment of all patient factors and identifies gaps and barriers to be addressed, is also required. Reimbursement Rates – CPT Code 99490 – $42/patient/month.
  • CPT Code 99439 (formerly  G2058) -This code allows providers to bill for each additional 20 minutes spent for Basic CCM services in a given month, up to 2 times. For example, if CCM services were provided for at least 40 minutes with a patient in a given month that was not Complex, 99490 ($42) and 99439 ($38) would be billed together for that month. Reimbursement Rates – CPT Code 99439 (formerly  G2058) – $38/patient/month.

Complex CCM:

  • CPT code 99487– This code has a higher rate of reimbursement than the Basic CCM CPT code. To bill using this code requires moderate or high complexity in medical decision making AND acknowledgment by both patient & provider of an acute exacerbation (generally defined as a sudden worsening of a patient’s condition that necessitates additional time and resources). The patient must receive at least 60 minutes of services from clinical staff within a given month to bill for this code. Reimbursement Rates – CPT Code 99487 – $93/patient/month.
  • CPT code 99489 – The same as with the Basic Chronic Care Management code, the Complex Chronic Care Management code also has an add-on CPT code to cover time spent beyond 60 minutes. It allows for billing for each additional 30 minutes spent for Complex CCM services within a given month. Reimbursement Rates – CPT Code 99489 – $45/patient/month.

Transitional Care Management:

Transitional Care Management (TCM) services address the hand-off period between the inpatient and community settings. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy. Family physicians often manage their patients’ transitional care.

medicare reimbursement codes

Requirements for TCM:

  • Contact the beneficiary or caregiver within two business days following a discharge. The contact may be via the telephone, email, or a face-to-face visit. Attempts to communicate should continue after the first two attempts in the required business days until successful.
  • Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision-making involved. The face-to-face visit is part of the TCM service and should not be reported separately.
  • Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.
  • Obtain and review discharge information.
  • Review the need for diagnostic tests/treatments and/or follow up on pending diagnostic tests/treatments.
  • Educate the beneficiary, family member, caregiver, and/or guardian.
  • Establish or reestablish referrals with community providers and services, if necessary.
  • Assist in scheduling follow-up visits with providers and services, if necessary.

CPT Reimbursement Codes for TCM Service:

  • CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge. Reimbursement  rate – $175.76/patient/month.
  • CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge. Reimbursement  rate – $237.11/patient/month.

Allowed reported services alongside TCM services include,

  • Prolonged services without direct patient contact (99358-99359);
  • Home and outpatient international normalized ratio (INR) monitoring (93792-93793);
  • End-stage renal disease (ESRD) services for patients ages 20 years and older (90960-90962, 90966, or 90970);
  • Interpretation of physiological data (99091); and
  • Care plan oversight (G0181-G0182).

Remote Patient Monitoring:

RPM involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition.

CMS

Requirements for RPM:

To qualify for CMS reimbursements for utilizing the RPM services efficiently, the service providers and hospitals need to ensure the following:

  • Medicare part B patients are imposed 20% of copayment (renouncing the copayments regularly can trigger penalties under the Federal Civil Monetary Penalties Law and also the Anti-Kickback Statute)
  • Patients must take the remote monitoring services and are required to monitor for a minimum of 16 days to be applicable for a billing period.
  • The RPM services must be ordered by skilled physicians or other qualified healthcare experts.
  • Data must be wirelessly synced for proper evaluation, analysis, and treatment.

CPT Reimbursement Codes for RPM Service:

  • CPT code 99453It is a one-time practice expense reimbursing for the setup and patient education on RPM equipment. This code covers the initial setup of devices, training and education on the use of monitoring equipment, and any services needed to enroll the patient on-site. Reimbursement  rate – $18.77/patient/month.
  • CPT code 99454This code covers the supply and provisioning of devices used for RPM programs, and the code is billable only once in a 30-day billing period. Reimbursement  rate – $64.44/patient/month.
  • CPT code 99457This code covers the direct monthly expense for the remote monitoring of physiologic data as part of the patient’s treatment management services. To receive reimbursement, the physician, QHP or other clinical staff must provide RPM treatment management services for at least 20 minutes per month. Reimbursement  rate – $51.61 (non-facility); $32.84 (facility) /patient/month.
  • CPT code 99458This code is an add-on code for CPT Code 99457 and cannot be billed as a standalone code. This code can be utilized for each additional 20 minutes of remote monitoring and treatment management services provided. Reimbursement  rate – $42.22 (non-facility); $32.84 (facility) /patient/month.

Principal Care Management:

PCM codes are intended to cover services for patients with only one complex chronic condition that requires management by a specialist. Like other chronic care management (CCM) codes (chronic care management, transitional care management), the PCM codes are intended to reimburse physicians for the additional work they do to take care of high-risk, complex patients. This includes the extra time and work required for medication adjustments, creating a care plan, patient follow-up, and more.

Healthcare technology

Requirements for PCM:

  • One complex chronic condition lasting at least 3 months, which is the focus of the care plan,
  • The condition is of sufficient severity to place the patient at risk of hospitalization or has been the cause of recent hospitalization,
  • The condition requires development or revision of a disease-specific care plan,
  • The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities

CPT Reimbursement Codes for PCM Service:

  • CPT Code G2064 – requires 30 minutes of provider (allergist, NP, PA) time each calendar month to care for the patient. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $52/patient/month.
  • CPT Code G2065 –  requires 30 minutes of clinical staff time directed by a provider each calendar month for patient care. Provider supervision does not require the provider to be onsite while clinical staff performs PCM services. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $22/patient/month.

Annual Wellness Visit:

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical.

healthcare solutions

Requirements for AWV:

For G0438 (initial visit),

  • Billable for the first AWV only.
    • Patients are eligible after the first 12 months of Medicare coverage.
    • For services within the first 12 months, conduct the Initial Preventive Physical Exam (IPPE), also referred to as the Welcome to Medicare Visit (G0402).
  • The patient must not have received an IPPE within the past 12 months.
  • Administer a Health Risk Assessment (HRA) that includes, at a minimum: demographic data, self-assessment of health status, psychosocial and behavioral risks, and activities of daily living (ADLs), instrumental ADLs including but not limited to shopping, housekeeping, managing own medications, and handling finances.
  • Establish the patient’s medical and family history.
  • Establish a list of current physicians and providers that are regularly involved in the medical care of the patient.
  • Obtain blood pressure, height, weight, body mass index or waist circumference, and other measurements, as deemed appropriate.
  • Assess a patient’s cognitive function.
  • Review risk factors for depression, including current or past experiences with depression or mood disorders.
  • Review patient’s functional ability and safety based on direct observation, or the use of appropriate screening questions.
  • Establish a written screening schedule for the individual, such as a checklist for the next 5 to 10 years based on appropriate recommendations.
  • Establish a list of risk factors and conditions for primary, secondary, or tertiary intervention.
  • Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
  • At the patient’s discretion, furnish advance care planning services.

For G0439 (subsequent visit),

  • Billable for subsequent AWV.
  • The patient cannot have had a prior AWV in the past 12 months.
  • Update the HRA.
  • Update the patient’s medical and family history.
  • Update the current physicians and providers that are regularly involved in providing the medical care to the patient, as developed during the initial AWV.
  • Obtain blood pressure, weight (or waist circumference, if appropriate), and other measurements, as deemed appropriate.
  • Assess a patient’s cognitive function.
  • Update the written screening schedule checklist established in the initial AWV.
  • Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.
  • Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
  • At the patient’s discretion, the subsequent AWV may also include advance care planning services.

CPT Reimbursement Codes for AWV Service:

The four CPT codes used to report AWV services are,

  • G0402 Initial Preventive Physical Exam – This code is used for patients visiting within 12 months after enrolling in Medicare.
  • G0438 Initial Visit – This visit is eligible within 11 calendar months from the date of IPPE.
  • G0439 Subsequent Visit – This code is used for every subsequent visit. Patients are eligible for this benefit every year after their Initial AWV.
  • CPT 99497/99498Patients are eligible for an Advance Care Planning (ACP) at any time. But if performed during an AWV, the patient has no copay.

Behavioral Health Integration:

Integrating behavioral health care with primary care (“behavioral health integration” or “BHI”) is an effective strategy for improving outcomes for millions of Americans with behavioral health conditions. Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period.

medicare cpt codes

Requirements for BHI:

  •  Any mental or behavioral health condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services.
  • The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time.

CPT Reimbursement Codes for BHI Service:

The CPT code used to report BHI services is,

  • CPT Code 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.

References:

https://signallamphealth.com/2021-medicare-cms-chronic-care-management-ccm-cpt-code-updates/

https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

https://college.acaai.org/new-principal-care-management-cpt-codes/#:~:text=G2064%20requires%2030%20minutes%20of,is%20%2452%2Fpatient%2Fmonth

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/transitional-care-management.htm

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf 

CMS expands Telehealth Services to Deliver Care Safely during COVID-19 and Beyond

During the COVID-19 pandemic, CMS has taken the necessary steps to make it easier to provide quality care through telehealth services. This unprecedented action by CMS has encouraged healthcare providers to adopt and use telehealth as a way to safely provide care to their patients in situations like medication consultation, eye exams, nutrition counseling, behavioral health counseling, and routine health check-ups like annual wellness visits. Past data have shown telehealth to be an effective medium for patients to access healthcare providers especially for managing chronic conditions like diabetes, asthma or to obtain mental health counseling.

Advantages of CMS changes to Telehealth:

telehealth reimbursement codes

Telehealth services made permanent post-COVID-19:

CMS has announced that 60 of the 144 telehealth services that were newly offered during the pandemic will become permanent. This includes services for cognitive assessment, psychological and neuropsychological testing, and custodial care services for established patients.

virtual healthcare

They have also finalized the decision that direct supervision in telehealth visits can be provided with interactive audio and video technology through the end of the year until December 2021. 

 

CPT Code

Services

Description

77427

Radiation management

It is reported once for every five fractions or treatment sessions regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days.

90853

Group psychotherapy

Group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.

90953

End-stage renal disease, one visit per month, ages 2 and younger

End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, etc.

90959

End-stage renal disease, one visit per month, ages 12-19

End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth 

90962

End-stage renal disease, one visit per month, ages 20 and older

With 1 face-to-face physician visit per month

92057

Speech/hearing therapy

Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual

92521

Evaluation of speech fluency

Evaluation of speech fluency (e.g., stuttering, cluttering)

92522

Evaluation speech production

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 

92523

Speech sound language comprehension

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)

92524

Behavioral quality voice analysis

Behavioral and qualitative analysis of voice and resonance.

96130

Psychological test Evaluation Phys/qhp 1st

Psychological testing evaluation services by a physician or other qualified healthcare professional, including the integration of patient data, interpretation of standardized test results and clinical data

96131

Psychological test evaluation phys/qhp ea

Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour

96132

Neuropsychological testing evaluation phys/qhp 1st

Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

96133

Neuropsychological testing evaluation phys/qhp ea

The first hour of neuropsychological evaluation is billed using 96132 and each additional hour needed to complete the service is billed with code 96133

96136

Psychological and neurological testing phy/qhp 1s

Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes

96137

Psychological and neurological testing phy/qhp ea

Similar to 96136. This code is used for each additional hour.

96138

Psychological and neurological tech phy/qhp ea

Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes

96139

Psychological and neurological testing tech ea

Similar to 96138. 

 97110

Therapeutic exercises

Foundational, occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility.

97112

Neuromuscular re-education

Specific exercises or activities performed and for what purpose, neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture.

97116

Gait training therapy

Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing). 

97161

Physical therapy evaluation 

Physical therapy evaluation of low complexity, 20 min

97162

Physical therapy evaluation 

Physical therapy evaluation moderate complexity, 30 min

97163

Physical therapy evaluation 

Physical therapy evaluation moderate complexity, 30 min

97164

Physical therapy evaluation

Physical therapy re-evaluation establish plan care

97165

Occupational therapy evaluation 

Occupational therapy evaluation low complexity, 30 min

97166

Occupational therapy evaluation 

Occupational therapy evaluation moderate complexity, 45 min

97167

Occupational therapy evaluation 

Occupational therapy evaluation high complexity, 60 min

97168

Occupational therapy 

Occupational therapy re-evaluation establish plan care

97535

Self-care management training

Direct one-on-one supervision and instruction regarding activities of daily living related to the patient’s health and hygiene.

97750

Physical performance test

Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.

97755

Assistive technology assessment

This procedure is used by the provider to assess the suitability and benefits of technological interfaces that will help restore, augment, or compensate for existing functional ability in the patient.

97760

Orthotic management and training 1st en

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes.

97761

Prosthetic training 1st enc

Prosthetic training, upper and/or lower extremities, initial prosthetic encounter, each 15 minutes

99217

Observation care discharge

This code is used to report all services provided to a patient discharged from outpatient hospital “observation status” if the discharge is on a date other than the initial date of “observation status

99218

Initial observation care

The first visit of the patient’s admission for outpatient hospital observation care by the Admitting/Supervising Physician or Other Qualified Healthcare Professional. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99219

Initial observation care

Similar to 99218 but, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99220

Initial observation care

Similar to 99218 but, 70  minutes are spent at the bedside and on the patient’s hospital floor or unit.

99221

Initial hospital care

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.

99222

Initial hospital care

Similar to 99221

99223

Initial hospital care

Similar to 99221

99234

Observation/hospital same date

Observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99235

Observation/hospital same date

Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99236

Observation/hospital same date

Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99238

Hospital discharge day

Used when time spent is less than 30 minutes on the discharge process in face-to-face evaluation.

99239

Hospital discharge day

Used when time spent is greater than 30 minutes on the discharge process in face-to-face evaluation.

99281

Emergency department visit

Requires these 3 key components: A problem-focused history; A problem-focused examination; and Straightforward medical decision-making. Usually, the presenting problem(s) are self-limited or minor.

99282

Emergency department visit

Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of low complexity. Usually, the presenting problem(s) are of low to moderate severity.

99283

Emergency department visit

Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of moderate severity.

99284

Emergency department visit

Requires these 3 key components: A detailed history; A detailed examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

99285

Emergency department visit

Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

99291

Critical care first hour

It is used to report the services of a physician providing full attention to a critically ill or critically injured patient from 30-74 minutes on a given date

99292

Critical care additional 30 mins

Code 99292 (critical care, each additional 30 minutes) is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care.

99304

Nursing facility care initial

The problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit.

  99305

Nursing facility care initial

The problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit.

99306

Nursing facility care initial

The problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit.

99315

Nursing facility discharge day

99315 is for discharge day management 30 minutes or less

99316

Nursing facility discharge day

This code is for discharge day management over 30 minutes

99327

Domiciliary or rest home visit new patient

Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99328

Domiciliary or rest home visit new patient

Code used for Evaluation and Management / Domiciliary, rest home (boarding home) or custodial care services. The general guidance for this code is that it is used for new patient assisted living visits, typically 75 minutes. 

99334

Domiciliary or rest home visit established patient

This code 99334 is used to reflect the domiciliary or rest home visit for the E/M of an established patient

99335

Domiciliary or rest home visit established patient

Similar to 99334

99336

Domiciliary or rest home visit established patient

Similar to 99334

99337

Domiciliary or rest home visit established patient

Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family

99341

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 1 new patient home visit.

99342

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 2 new patient home visit.

99343

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 3 new patient home visit.

99344

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 4 new patient home visit.

99345

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.Level 5 new patient home visit.

99347

Home visit established patient

Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components.  A problem-focused interval history; a problem-focused examination; and straightforward medical decision making. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99348

Home visit established patient

Similar to CPT Code 99348. Typically, 25 minutes are spent face-to-face with the patient and/or family.

99349

Home visit established patient

Similar to CPT Code 99348. Typically, 40 minutes are spent face-to-face with the patient and/or family.

99350

Home visit established patient

Similar to CPT Code 99348. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99468

Neonatal critical care initial

Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger. 

99469

Neonatal critical care initial

Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger. 

99471

Pediatric critical care initial

Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99472

Pediatric critical care initial

Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99473

Self-measurement of blood pressure at home education/training

Code 99473 represents the work of training the patient and calibrating the device,

99475

Pediatric critical care ages 2-5 initial

Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

99476

Pediatric critical care ages 2-5 subsequent

Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

99477

Initial day of hospital care for neonatal care

Initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services.

99478

Ic low-birthweight infant

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( < 1500 gm)

99479

Ic low-birthweight infant < 1500-2500 g subsequent

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( 1500 gm-2500g)

99480

Ic infant pbw 2501-5000 g subsequent

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant(2501g-5000g)

99483

Assessment and care plan cognitive impairment

Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home

The ongoing pandemic has resulted in an increased workload for healthcare providers across the country. Incorporating telehealth software into an existing practice can allow providers to virtually connect with patients. This can relieve the strain on practice while introducing an additional revenue stream.

HealthViewX Telehealth/Telemedicine Platform helps health systems to align clinical, financial, and operational goals by providing high-quality remote care and enhancing patient-physician collaborations.

References: https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

The Importance of Clinical Call Center Nurses in the RPM Care Journey

The emergence of Remote Physiological Monitoring (RPM) has greatly contributed to the rapid adoption of virtual health services. This practice would not be possible without the work of clinical call center nurses, who observe the condition of patients and accordingly make relevant health decisions.  

How does RPM work?

RPM uses technology to track a patient’s vital parameters such as heart rate, blood pressure, weight, etc. This data is recorded by the device and sent to health professionals involved with the patient’s care. The care provider can then make informed decisions on the patient’s health. RPM devices notify the care provider if any abnormal vitals are detected. They also allow patients to receive quality health care from a virtual setting. Effective RPM systems result in higher patient satisfaction while increasing the revenue of care providers.

how does call centers help remote patient monitoring

The role of Call Centers in RPM

Clinical Call Centers play a crucial role in the RPM care journey. RPM devices track a large number of complex metrics relating to the patient’s health. Any data recorded by an RPM device is useless until a qualified health professional is able to analyze it. This is where call center nurses factor into the Care Journey. The RPM device emits data through the provider’s RPM software to the clinical center. Here the data can be received and analyzed by the nurses in charge of the virtual patient care. They can record a patient’s progress and better understand how a patient responds to treatment. If there are any slight deviations from the care plan, nurses can video conference with the patient to identify and address the source of the irregularity. If there are any concerning metrics, the nurses can immediately connect the patient with the necessary professional. 

How RPM help Call Center Nurses

Call Center Nurses may be in charge of monitoring hundreds of patients in a virtual manner. Without a Remote Monitoring option, nurses need to manually contact individual patients. RPM devices can connect with these patients on a daily basis, without constant human interaction. These devices can collect the data of hundreds of patients and send these results to the call center in just a few minutes. RPM also allows patients to track their health from the comfort of their homes-meaning providers are able to turn their attention to their most at-need patients. 

RPM and the COVID-19 Pandemic

The COVID-19 pandemic has heightened the importance of virtual care services like RPM. The pandemic has greatly decreased the healthcare industry’s focus on combating non-COVID related ailments. However, providers with existing RPM mechanisms are benefiting from the ability to monitor health through a virtual platform. In addition, patients who suffer from chronic conditions are still able to receive daily updates on their health. 

Characteristics of a functional RPM platform

The following characteristics can be found among all effective RPM systems:

  1. Reduce Emergency Situations: RPM devices can track any abnormal patterns and immediately report them to a health center. Emergency situations are of increased danger to the health of chronic care patients. RPM devices can provide a timely intervention and allow the patient to receive care before an emergency situation unfolds. 
  2. Reduce Readmissions: An efficient RPM platform can prevent patients from being readmitted for their existing conditions. By tracking the trajectory of the patient’s health, nurses can notify patients when they deviate from their care plan. This helps patients stay on top of their treatment while decreasing the probability that they are readmitted. 
  3. Increased Patient Involvement: The interactive nature of RPM gives patients the opportunity to be more involved in their care. This means patients are more informed on their condition and the treatment plan referred to them. Ultimately a more involved patient increases the likelihood of recovery. 

The increased importance of virtual care has allowed RPM to emerge as a powerful tool in care delivery. The proper use of these technologies greatly enhances the convenience and effectiveness of health care.

Schedule a demo and learn how HealthViewX is transforming the Care Journey for both patients and providers!

How Early Adopters of Healthcare Technologies Are Benefited

Today, healthcare technology has extensively transformed the healthcare sector by changing the lives of many people and also changing the way the healthcare industry operates. It is driving healthcare more than any other force and has resulted in meaningful growth for the future. It has helped the industry by bridging the communication gap between patients and providers.

Though American healthcare providers have embraced the use of EHRs at record-high rates, they lag behind the rest of the world in adopting other digital health technologies such as telehealth, artificial intelligence, etc.

Early Adopters of Healthcare Technology Are Benefitted

There is no denying that the early adopters of healthcare technology are benefitting the most. It is extremely advantageous to providers and has played a pivotal role in bringing noticeable changes to the healthcare industry. There are providers skeptical about the implementation cost and the medical value of technological advances.

Though there remains skepticism among providers about healthcare IT, this situation is likely to change among the U.S. medical providers. Efforts are underway to increase the adoption of healthcare IT and spur innovative solutions. The early adopters are witnessing optimistic results like the ability to provide better care, the reduction of administrative costs, and the power to provide value-based care for their patients.

Related Article: Data Analytics Next “Big Thing” in the Healthcare Industry!

Some of the benefits are

The adopters are benefitting from the increased revenue government reimbursements for Medicare patients. This allows them to optimize their potential revenue and provide value-based care for their patients.

The adopters have been able to retain and expand their patients through a well-connected care system.

Healthcare IT lets patients have access to their health records, allowing them to take part in their care programs or plans.

With the help of electronic health records, patients have been more engaged in their health and have greater satisfaction with care.

The providers have been able to retain and expand their patient base with value-based care and better results.

Health IT provides 360-degree care which enables both the patients and providers to have a better understanding of the patient’s current health condition and unique healthcare needs thus enabling the physician to come up with individual care plans.

Eventually the adoption of health IT will bring great changes in the healthcare system benefitting both the providers and the patients.

benefits of Early Adopters of healthcare industry

Early adopters, in general, are experiencing the following benefits as well:

  • Connected health helps patients to self-manage their health thus supporting the physicians for a better health outcome.
  • Providers are able to retain and expand their patient base while focusing on value-based care
  • Providers are able to bring in additional revenue by increasing their patient base and aligning with their business strategy.
  • Early adopters are maximizing their profit through increased revenue government reimbursements for Medicare patients.
  • Adopting health IT reduces the cost of care for their patients.
  • The technology behind health IT is advancing rapidly and is transforming the way the industry operates.
  • Healthcare IT enables the secure exchange of sensitive patient data.
  • Health care IT has helped to build better patient-provider relationships.
  • Detailed care - Provides physicians more face time, improved outcomes, focus on preventive measures, reduced readmissions, and reduces paperwork.
  • Patients will experience higher satisfaction, increased confidence, and enhanced treatment adherence.
  • Enables better care quality and patient-centered care.

In Conclusion, health IT can tackle the increasing demands on healthcare. It is especially advantageous for the industry considering the increase in chronic diseases and people with multiple conditions. Healthcare technology has the potential to improve the overall outcome by reducing healthcare costs and increasing access to care.

Talk to HealthViewX Solution experts to understand more about their HOPE Platform and solutions like Referral Management, Chronic Care Management, Telehealth Solutions, Remote Patient Monitoring, and many more. Schedule a demo today!

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

          Referring physicians refer patients to out-of-network providers

          Patients move out of the care network due to poor care coordination

          Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective.  Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

  • Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.


  • Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.


  • Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.


  • Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.


  • Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.  

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

Five Ways To Reduce Patient Referral Leakage In Hospitals And Health Systems

Hospitals and health systems know that referrals are critical for their business, and failing to manage referrals efficiently can result in loss of revenue. Healthcare providers are losing more than 20% of revenue to patients going out-of-network for care. Most of these hospitals and health systems do not know why and where referral leakage occurs.

It’s only within the past few years healthcare leaders see patient referral leakage as a major issue, and fixing it is their high priority – Missed appointments alone cost the US healthcare system $150 billion annually. Healthcare organizations do not have a solution in place to monitor, track, and report patient referral leakage. They use their electronic health records to monitor and track referral leakage rather than having specific solutions, but healthcare leaders are not happy about how their EHR performs in this particular area.

Today, most hospitals and health systems leverage technology to prevent revenue leakage due to inefficient referral process. Tracking patient referral leakage through a referral solution gives them a complete view of their end-to-end referral process.  Technology helps providers enhance care delivery, improve patient outcomes and use of data, and support collaborative workflows.

Here are five ways to reduce patient leakage:

Understand their referral patterns so far:

Organizations should analyze past data to understand their referral patterns. By tracking the right metrics they will not only gain valuable business acumen but also understand how the hospital is performing. Hospitals today use EHR to get this data but it is not streamlined enough to crunch all the data in a logical and meaningful way.

Improve care-coordination:

Effective and efficient communication is crucial in healthcare. Patients need to receive the right level of care from their care providers. It is important to communicate effectively with all who are actively involved in patient care.

Proceed with a data-driven approach:

A data-driven approach will have a sustainable competitive advantage over those who haven’t. The right way to make decisions is by looking at the data. Understand where the leakage is happening and if it is addressable. Health systems/ Hospitals need to use a data-driven approach to guide patient referrals to the best care option available within the network. Such an approach will help meet both the patients’ and hospital needs.

Use prognostic modeling to know the implications of future referral patterns:

Organizations need to understand how fixing referral patterns today may change future referral patterns by using predictive modeling. It’s essential to analyze how these alterations will impact patient flow, care delivery and coordination with referring providers and payers.

Include it as strategic precedence and discuss at the executive level:

Patient leakage more often gets lost among other priorities at the executive level. Organizations need to make patient referral leakage a strategic priority. Top management should drive change and ensure necessary steps are taken to address this challenge.  

Tracking and understanding referral patterns will help the large hospitals streamline and manage high- overall performance referral networks, decrease patient leakage and notably impact care quality.

HealthViewX Patient Referral Management Solution smoothens the referral process and solves most operational challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management Solution? Schedule a demo now!