Congressional telehealth bill could eliminate 16-day RPM reading requirement
While last week’s news from the AMA that the proposed changes to the RPM CPT® code requirements, including lowering the 16-day requirement threshold was disappointing, there’s hope from Congress. The bipartisan Energy and Commerce Committee has passed 21 telehealth bills, including H.R. 5394, — Expanding Remote Monitoring Access Act — which would allow billing for 2-15 days of RPM data.
The bill, which was passed unanimously, specifically points out that even CMS understands that 16 days aren’t always required. The bill states, “CMS concluded that ‘we agree that a full 16 days of monitoring may not always be reasonable and necessary’ but did not revise the 16 day per 30- day period minimum duration for all patients because CMS did not believe they had received ‘specific clinical examples’ to allow for ‘understanding under what clinical circumstances fewer days of monitoring would be medically reasonable and necessary and allow a practitioner to establish clinically meaningful care’ ”.
The bill goes on to site specific examples where clinical evidence shows fewer than sixteen days of monitoring within a 30-day period establishes clinically meaningful care, including:
- Sleep apnea
- Monitoring breathing while taking narcotic prescriptions
- Weight monitoring for chronic conditions including diabetes, CHF, or obesity
- Measuring blood pressure or oxygen levels during physical therapy
- Monitoring heart palpitations
- Long-term hypertension monitoring
- Respiratory issues
Additional use cases for RTM included pre-and post-surgery function for total joint replacement, exercise for patients with Muscular Sclerosis, and cognitive behavioral therapy.
It’s encouraging that Congress recognizes the benefits of RPM, specifically for the Department of Veterans Affairs, and sites the potential of RPM to reduce bed days and admissions, improve access to care, enhance clinical outcomes, and lower healthcare costs.
We are looking forward to following more good news to emerge from the proposed telehealth bills.
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