Payment Rates for Remote Heart Failure Monitoring
During Medicare's open public comment period for defibrillator indications, I made an effort to standardize reimbursement for remote physiologic monitoring. It is currently priced in an unstable and unfair way that has deterred many healthcare organizations from establishing and appropriately staffing heart failure clinics. Current pricing policy also makes remote monitoring price-prohibitive for many patients. For the same service, patients in one state must pay almost 15 times more out-of-pocket than patients in other states. It's unfair to patients, it's unfair to providers, and it is unfair to tax payers.
According to the Centers for Disease Control, heart failure costs the United States almost $31 Billion each year. Heart failure is the #1 reason why Medicare patients get admitted to the hospital and it is the #1 expense for Medicare. Many of these admissions and expenses can be avoided by actively managing patients in heart failure clinics and by utilizing remote physiologic monitoring.
The technical service of remote physiologic monitoring is billed with code 93299. This code was introduced in 2009 and listed as a "Contractor Priced" CPT code. This pricing approach lets Medicare analyze the proliferation of a service based on regional reimbursement variables and determine appropriate national payment levels. It seems as if somebody dropped the ball because, 8 years later, code 93299 is still Contractor Priced.
The recommendation I submitted to Medicare is presented below. If you agree with this, please share it with your network. Medicare will be looking for additional input before they finalize a new policy. Many people have no idea that this is a concern. But it is a HUGE one!
"Some pacemakers and defibrillators can also monitor physiologic data that can be useful when managing heart failure. Medicare has not established a national reimbursement amount for the technical component of this service (CPT 93299). Instead, this code has been “contractor priced” since it was published. As a result, providers in some states receive $13/month for this code while others receive $204/month. For traditional Medicare, this means that a patient in one state would need to pay $490/year in out-of-pocket expenses for the same service that a patient in another state must only pay $31/year for."