Question: How do I code for the download and interpretation of smart card/cloud-based data related to PAP usage?
Answer: There is no CPT® code that exactly describes the download and interpretation of smart card/cloud-based PAP data. The service is best described by code 99091, which describes the collection and interpretation of physiologic data.
Effective January 1, 2018, CPT code 99091 was unbundled by CMS, and a separate payment is being finalized so that eligible practitioners can bill to receive separate reimbursement for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider. The work must include a minimum of 30 minutes of physician time over a 30-day time frame.
The code is payable in both facility and non-facility settings; however, to ensure an eligible transaction, healthcare providers must first hold a face-to-face consultation with patients who are new (or who have not been seen within one year of the implementation of the remote care services), obtain advanced beneficiary consent for the services, and document this in the patient’s electronic medical record.
CMS is allowing CPT code 99091 to be billed once per patient during the same service period as chronic care management (CPT codes 99487, 99489, and 99490), Transitional Care Management (CPT codes 99495 and 99496), and behavioral health integration services (CPT codes 99492, 99493, 99494, and 99484). CMS also stipulates that this should not be billed more than once every 30 days.
Providers are encouraged to contact the private payers they work with to determine if 99091 is a payable code.
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