CMS Reimbursement Codes 2020

Digital health companies and innovation-focused provider and payer systems cheered the recent Current Procedural Technology (CPT) code changes, revisions, and deletions that are on deck for implementation through the American Medical Association (AMA) on January 1, 2020.

With 394 changes, many of the codes will focus on providing reimbursement for routine practices surrounding e-health and televisits, such as reimbursement for patient-initiated digital communication through tools like patient portals, and codes to report self-measured blood pressure (99473, 99474).

The codes were primarily focused on promotion the integration of home-based services ‘that can be a significant part of a digital solution for expanding access to healthcare, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care’, according to AMA President Patrice A. Harris, MD, MA. The high volume of changes include 284 new codes, 71 deletions, and 75 revisions. New codes surround medical services initiated by digital communication from patients to clinicians (99421, 99422, 99423) and non-clinicians (98970, 98971, 98972).

Another area of focus is around health and behavior assessment and intervention services (96156, 96158, 96164, 96167, with add-on codes 96159, 96165, 96168, 96171).

The AMA also states that one of the most significant expansions to prior and current CPT codes was due to the need for codes to reimburse long term electroencephalographic (EEG) monitoring services which monitor the brain’s electrical activity, and are key in the diagnosis of epilepsy (95700-95726).

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