Which Category Should You Choose
Summary and considerations
It is important to realize that, as stated in the program outlines above, you can only bill a patient for only one category during a calendar month. Therefore, you should bill for the category with the greatest amount of reimbursement. The category of non-complex CCM can almost be ruled out. As the add-on CPT code 99437 can only be billed twice per calendar month, reimbursement for this category is capped at $156 per-month based on national reimbursement averages. That amount barely covers the costs associated with the technology. In larger integrated health systems where more clinical staff is usually available, it would be highly inefficient for providers to be saddled with tasks that could be provided by lowered credentialed staff. Intersect believes that whenever possible, the clinical staff complex CCM management is the best choice. For patients not meeting that criterion, CPT codes for remote patient monitoring should be considered in lieu of CCM codes.
Regardless of the amount of revenue from reimbursements, that will be less than the organizational savings due to a reduction in ED visits and readmissions. That savings will be a factor of the cost per each incident times the reduction in their number. In a recent study of Asthma patients at Northwestern Medicine, the medial length of time between who had follow-up visits with their provider was 131 days while the median length of time between exacerbations for patients WHO DID NOT see their outpatient provider within one month was 46 days. Remote patient monitoring works! U.S. Patent Pending