Remote Patient Monitoring New York
NY Medicaid is authorized to establish fees to reimburse the cost of telehealth remote patient monitoring, per a State Plan Amendment submitted and approved by CMS.
Remote patient monitoring (RPM) can include synchronous or asynchronous electronic information and communication technologies to collect personal health information and medical data. RPM may be provided by a facility licensed under Article 28 of Public Health Law or by a physician, nurse practitioner, midwife or physician assistant who has examined the patient and with whom has an established relationship.
Source: CMS Approved state plan amendment 16-0015. Attachment 3.1A. (Accessed Sept. 2019).
RPM included within the definition of “telehealth” in the statute requiring Medicaid not exclude from the payment the delivery of home health services through telehealth.
Source: Social Services Law Title 11, Article 367-u. & NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Sept. 2019).
Remote patient monitoring services are billed using CPT code “99091” and should not be billed more than once per member per month. Billing should occur on the last day of each month in which RPM is used. A fee of $48.00 per month will be paid for RPM for a minimum of 30 minutes per month spent collecting and interpreting a member’s RPM data. FQHCs that have opted out of APGs are unable to bill for RPM services.
Source: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11-12. (Accessed Sept. 2019).
A Medicaid member must be present during the remote consultation in order to be reimbursed.
Source: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3. (Accessed Sept. 2019).
Medical conditions that may be treated/monitored by means of RPM include, but are not limited to:
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Wound care
- Mental or behavioral problems
- Technology-dependent care, such as continuous oxygen, ventilator care, total parenteral nutrition, or enteral feeding.
Source: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4. (Accessed Sept. 2019).
The following considerations apply to RPM:
- Medical conditions that may be treated/monitored by means of RPM include, but are not limited to, congestive heart failure, diabetes, chronic obstructive pulmonary disease, wound care, polypharmacy, mental or behavioral problems, and technology-dependent care such as continuous oxygen, ventilator care, total parenteral nutrition or enteral feeding.
- RPM must be ordered and billed by a physician, nurse practitioner or midwife, with whom the member has or has entered into a substantial and ongoing relationship.
RPM can also be provided and billed by an Article-28 clinic when ordered by one of the previously mentioned qualified practitioners.
- Members must be seen in-person by their practitioner, as needed, for follow-up care.
- RPM must be medically necessary and shall be discontinued when the member’s condition is determined to be stable/controlled.
- Payment for RPM, while a member is receiving home health services through a Certified Home Health Agency (CHHA), is pursuant to PHL Section 3614 (3-c)(a) – (d) and will only be made to that same CHHA.
Source: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4-5. (Accessed Sept. 2019).