The Updated 2024 Medicare Physician Fee Schedule Includes Expanded Remote Care Management for FQHCs and RHCs

7 months ago

By Paul Huffman, Chief Revenue Officer

First Impressions

  • Remote patient monitoring becomes further entrenched in the continuum of care.
  • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are big winners.
  • There is still a requirement of 16 days of connectivity, alerts, and reminders during a 30-day period.
  • After years of waiting, RHCs and FQHCs can implement RPM and CCM at the same time with compensation.
  • New Patient-First Care rules mean care delivery can be tailored to each patient.
  • Vitals monitoring and Health Coaching are now available for patients.

Reimbursement for Remote Patient Monitoring

Starting Jan. 1, 2024, Medicare will begin reimbursing FQHCs and RHCs for remote patient monitoring (RPM). Providers will be eligible to bill for two remote health monitoring services under the general care management code G0511, at a rate of $71.68 per patient per month. These services include:

  • CPT 99454: Reimburses for the use of smart-enabled remote patient monitoring systems that transmit biometric readings to a digital platform. The patient must transmit at least 16 days of readings in a 30-day period.
  • CPT 99457: Reimburses for 20 minutes of clinical staff time spent monitoring and coordinating care for an RPM patient, including live interaction with the patient.

Reimbursement for Remote Therapeutic Monitoring

Starting Jan. 1, 2024, Medicare will begin reimbursing FQHCs and RHCs for remote therapeutic

monitoring (RTM). These codes are also bundled into G0511 and include these services:

  • 98976: Supply of the RTM device, collection, and reporting for respiratory.
  • 98977: Supply of the RTM device, collection, and reporting for musculoskeletal.
  • 98980: First 20 minutes of RTM time spent.

FQHCs and RHCs will be able to bill G0511 multiple times per month for the same patient, provided that the minimum requirements are met for each code.

Enrollment into Services Under General Supervision

During the COVID-19 PHE waiver, Medicare allowed FQHCs and RHCs to enroll patients into care management programs remotely. This waiver helped clinics enroll and provide services for many more patients throughout the pandemic. The initial waiver expired in May of 2023 when an end to the PHE was declared. CMS has made the waiver permanent starting Jan. 1st of 2024. The new rule, along with coverage expansion for RPM services, will increase patient access to remote care programs.

G0511 Reimbursement Rate Reduction Offset by Increased Volume and Access to Care

While CMS has updated the rule to reflect multiple billing for G0511, there is a nominal reduction in the reimbursement rate from $77.24 in 2023 to $71.68 in 2024. However, the overall effect of the rule will produce a net upside for providers and their patients, while also improving access to important services like RPM, RTM, BHI, in addition to CCM.

MD Revolution’s Technology and Services Can Help Providers Transition to RPM and Provide Excellent Patient Care in Accordance with New Rules

  • MD Revolution’s hub-based devices enable two-way communication with patients and scale to deliver multiple services with the same care terms and integration.
  • MD Revolutions smart alerts, reminders, and text capabilities enable providers to meet care requirements.

To discuss the new rule and how MD Revolution can enhance your remote care journey, book my calendar directly.

Click here to read the 2024 Medicare Physician Fee Schedule Summary.

MD Revolution is transforming remote care management.

Serving over 150,000 patients and hundreds of providers with multiple solution pathways to choose from, MDR extends your care for RMP, CCM, BHI, AWV, TC and more. MD Revolution is the FQHC and RHC preferred partner in remote care technology, outreach, and health coaching. Whether you need best in class technology engagement solutions or a full suite of technology, engagement and clinical health support, MD Revolution meets FQHCs and RHC where they are, to extend care for the patients they serve.