The CPT code set is moving at the speed of digital health innovation

Physician adoption of digital health tools continues to grow, as does the infrastructure facilitating appropriate payment for their use. The Current Procedural Terminology (CPT®) code set, often referred to as the “language of medicine,” is expanding to meet the demand.

“The CPT code set moves at the pace of medicine and continues to evolve and keep up with all the changes,” said Leslie Prelwitz, AMA director of CPT content management and development.

“When you look at digital medicine, the areas of significant physician interest, trust, utility and patient care also have significant CPT code representation,” Prelwitz said during a recent AMA webinar on telehealth, other digital health tools and CPT coding.

The webinar based on the latest findings from an AMA survey of physicians (PDF) showing that adoption of digital tools has grown significantly among all physicians, regardless of gender, specialty or age. Improved clinical outcomes and operational efficiency have been identified as key drivers of adoption.

Telehealth support is an essential component of the AMA’s recovery plan for America’s physicians. Telehealth is critical to the future of health care, which is why the AMA continues to lead the charge to aggressively expand telehealth policy, research, and resources to ensure physician practice sustainability and equitable reimbursement.

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“The adoption of remote care tools, such as televised visits or telehealth and remote monitoring, have seen the most movement,” said Meg Barron, AMA vice president of digital health innovation.

“This is not a big surprise given the surge in use during the pandemic,” Barron added. “But when you think about it, the use of telehealth has tripled since 2019, which is a huge change.”

Digital health encompasses a wide range of tools beyond telemedicine and wearable remote monitoring devices, applications, and more. The digital health tools that generate the most enthusiasm among doctors are televised visits (57%), followed by remote monitoring devices (53%).

In terms of ensuring proper payment, the CPT code set classifies recent applications as Remote Physiological Monitoring (RPM) or Remote Therapeutic Monitoring (RPT) tools.

The RPM CPT codes were created in 2019 and cover device setup, patient education on device use, device delivery, and patient management.

RPM codes are intended for use when monitoring patient physiological parameters such as weight, blood pressure, pulse oximetry, or respiratory flow rate.

RTM CPT codes were released this year and are also used for device delivery, device setup, and patient education on their use, plus patient adherence and response to therapy.

“Therapeutic monitoring is really able to look at the impact of a particular treatment regimen,” Prelwitz said.

Although much expansion is anticipated, current RTM codes focus on musculoskeletal status, respiratory status, cognitive behavioral therapy, adherence to therapy and therapeutic response, and review and monitoring of data related to therapeutic response.

Associated codes include:

  • 98975 to report initial setup, patient education, and equipment use.
  • 98976 and 98977 to report delivery of a scheduled recording device or transmission of a program alert for respiratory or musculoskeletal monitoring every 30 days.

Use of digital therapy is low (11%), but a greater share of physicians (40%) report plans to incorporate the technology in the next year than for any other new digital health tool.

“Despite RPM’s growth, it’s still the least used of the solutions we asked about,” Barron said. “It just speaks to the market share opportunity we have — and the role technology can play in addressing chronic disease.”

The ability of digital health tools to help reduce stress and burnout has also gained importance as a key driver of adoption, she added.

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Another category of CPT codes launched this year includes remote therapeutic monitoring and treatment management services. The codes for these services are counted for the time spent per month:

  • 98980 counts the first 20 minutes of treatment management services.
  • 98981 counts each additional 20-minute period of treatment management services.

Last year, the CPT Editorial Panel, mandated by the AMA Board of Trustees to review, update, and modify CPT codes, descriptors, rules, and guidelines, adopted a taxonomy to describe healthcare services or procedures delivered through augmented intelligence (AI)—often referred to as “ artificial intelligence.” The document’s guidelines, contained in Appendix S to the CPT code set, went into effect in January.

Codes being added in 2023 for digital ophthalmology services include:

  • 0704T0706T for remote amblyopia treatment using an eye tracking device and overlay device delivery, technical support, interpretation and report.

Also added in 2023 are CPT codes allowing for remote examination by pathologists or in conjunction with the use of AI algorithms.

  • 0751T–0763T involves the digitization of glass microscopic slides, enabling remote examination by the pathologist and/or in conjunction with the use of artificial intelligence (AI) algorithms. .

“There’s a whole series of codes in that section,” Prelwitz said. “It’s very new and you don’t see this type of progress all the time on this scale.”

A dedicated CPT Education section has been created for the AMA Ed Hub™, an online learning platform containing CME and education, including a series of modules covering an overview of CPT coding basics and other topics. The CPT Network is also available for authoritative CPT coding guidelines.

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