Digital Medicine Payment Advisory Group initiative

Digital medicine presents an opportunity to improve access and to offer cost-effective medical care to a large swath of patients with varied needs. To maximize this potential, over the past several years, the CPT® Editorial Panel (Panel) has made significant progress in establishing CPT codes for digital medicine services.

These CPT codes have provided holistic coding solutions that not only account for the physician/qualified health care professional work, but also the practice expense cost of clinical staff and the software/devices used in capturing these data.

The catalyst for many of these changes has been the Digital Medicine Payment Advisory Group (DMPAG). DMPAG is a collaborative initiative—convened by AMA—that engages a diverse cross-section of nationally recognized experts. Along with the support of national medical specialties, the CPT Category I codes have gone through AMA/Specialty Society RVS Update Committee (RUC) valuation.

Increasing coverage requires a concerted effort by knowledgeable professionals as well as input, such as pertinent use cases and clinical data that demonstrate the efficiencies and clinical benefits of digital medicine.

Creating a clear pathway for integration of digital medicine technologies into clinical practice

Areas of focus for the advisory group include:

—Create and disseminate data supporting the use of digital medicine technologies and services in clinical practice.

—Review existing code sets (with an emphasis on CPT and HCPCS) and determine the level to which they appropriately capture in current digital medicine services and technologies.

—Assess and provide clinical guidance on factors that impact the fair and accurate valuation for services delivered via digital medicine.

—Provide education and clinical expertise to decision makers to ensure widespread coverage of digital medicine (e.g., telemedicine and remote patient monitoring), including greater transparency of services covered by payers and advocacy for enforcement of parity coverage laws.

—Review program integrity issues including, but not limited to, appropriate code use, and other perceived risks unique to digital medicine. Develop guidance and clarity on issues to diverse stakeholder groups.

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Advisory Group members

Members are selected based on individual expertise and experience, not as a representative of a specialty society, institution, association or company.

Joseph C. Kvedar, MD, FAAD (co-chair)

Vice president, Connected Health at Harvard Partners HealthCare

Karen S. Rheuban, MD (co-chair)

Professor of pediatrics (cardiology), senior associate dean for continuing medical education and director of the Center for Telehealth, University of Virginia

Peter A. Hollmann, MD

Chief medical officer, University Medicine at Brown University, Alpert Medical School, Department of Internal Medicine Faculty Practice

Robert Jarrin, JD

The Omega Concern, LLC

David Kanter, MD, MBA, CPC, FAAP

CPT Editorial Panel committee member
Vice president, medical coding, MEDNAX Services, Inc.

Katharine L. Krol, MD, FSIR, FACR 

Former CPT Editorial Panel executive committee member; CPT liaison to the RUC Panel 

Demetrios L. Kouzoukas

Former director, Center for Medicare and former principal deputy administrator, Center for Medicare & Medicaid Services

John Mattison, MD

Chief medical information officer and assistant medical director, Kaiser Permanente 

Jordan Pritzker, MD, MBA, FACOG

CPT Editorial Panel committee member; CPT liaison to the RUC Panel
Senior medical director for medical policy and operations at Aetna, Inc. 

Peter A. Rasmussen, MD, FAHA, FAANS

Medical director for distance health and associate professor of neurosurgery, Cerebrovascular Center at the Cleveland Clinic, Cleveland, Ohio

Morgan Reed

Executive director, ACT | The App Association 

Ezequiel “Zeke” Silva III, MD, FACR, RCC

Director of interventional radiology, South Texas Radiology Imaging Centers
Diagnostic and interventional radiologist, South Texas Radiology Group, San Antonio, Texas

Laurel Sweeney

Principal, Access Strategies, LLC

Featured telehealth coding highlights

The CPT® Editorial Panel has a long history of creating coding solutions to meet the needs of digital medicine and telehealth.

The relatively low adoption of telehealth services within physician practices and health systems across the country, prior to the COVID-19 crisis, was largely due to restrictive coverage and payment regulations from Medicare and commercial payers. This is not due to a lack of coding options within the CPT code set. Furthermore, CPT codes for digital medicine (e.g. remote patient monitoring) have broad adoption within Medicare and commercial payers, especially within the last two years.

Remote monitoring

To address broader remote monitoring use cases, the DMPAG worked with the CPT Editorial Panel in creating remote physiologic monitoring codes. This initial set of codes became effective in 2019, and in 2020 an additional code was created to report additional physician/QHP time related to remote monitoring.

Importantly, these services have been used by physicians who have taken care of some of the first COVID-19 patients in the U.S by managing pulse oximetry data from the patient’s home to keep them out of the emergency room and the inpatient hospital, unless it becomes necessary.

In addition, the CPT code set has specific codes for monitoring services that require unique work beyond general remote physiologic monitoring.

—Remote monitoring of a wireless pulmonary artery pressure

—Pediatric home apnea monitoring event recording

—Self-measured blood pressure using a device validated for clinical accuracy

Online digital visits (e-visits)

These services are the kind of brief check-in services furnished using communication technology that are employed to evaluate whether an office visit or other service is warranted. This is often done through a patient portal or smartphone. Each code specifies the amount of time spent during the online evaluation of a patient.

These codes are especially helpful during the COVID-19 crisis due to the inability for patients to see a physician or non-physician qualified health care professional face-to-face.

Interprofessional internet consultations

The CPT code set has several codes to allow the reporting of electronic, non-verbal communication between consulting and treating/requesting physicians. While codes currently exist to report verbal and written reports, no codes previously existed to report the sending of results without additional verbal communication.

Telephone evaluation and management services

CPT codes to describe telephone evaluation and management services have been available since 2008. Relative values are assigned to these services. Medicare still currently considers these codes to be non-covered. However, private payers may pay for these services. Each corresponding code describes the amount of time of medical discussion.