The AMA Digital Medicine Payment Advisory Group identifies barriers to digital medicine adoption and proposes comprehensive solutions on coding, payment, coverage and more.
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.
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.
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
Partner, Team8; former director (Center for Medicare) and 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
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
Principal, Access Strategies, LLC
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