Remote Physiologic Monitoring with Icare® HOME Tonometer
FREQUENTLY ASKED QUESTIONS:
REMOTE PHYSIOLOGIC MONITORING WITH ICARE HOME TONOMETER
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Q: What is the Icare® HOME tonometer?
A: The Icare® HOME tonometer is a hand held device that a trained and certified patient can use to safely and reliably measure intraocular pressure (IOP) at home on an occasional basis without local anesthesia. It is FDA cleared and available in the US. Compared with Goldmann applanation tonometry (GAT), the Icare® HOME measurements agreed with GAT within 5 mm Hg in 91% of patients. The mean difference between Icare® HOME and GAT was -0.33 mm Hg (SD 3.11). Most patients (84%) can be certified to use the Icare® HOME, but not all, and some patients (6%) have difficulty using the device even after training.
Q: What is remote physiologic monitoring (RPM)?
A: For CMS, remote physiologic monitoring is associated with chronic care management (CCM) of two or more serious conditions expected to last at least a year.4 Here, the focus is on moderate to severe glaucoma with above-average risk for disease progression with co-existing chronic conditions – either systemic or ophthalmic. An example is hypertension.
Candidates for RPM using the Icare HOME are Medicare beneficiaries currently under care of an ophthalmologist or optometrist for two or more serious conditions, one of which is glaucoma, who would benefit significantly from RPM. These patients are likely poorly controlled. The ophthalmologist or optometrist provides the Icare HOME for the patient’s use, reviews the collected IOP measurements, and telephones the patient or caregiver each month to discuss the findings and treatment plan. It is hoped that RPM engages the patient in their treatment, improves disease management, and reduces the cost of care.
Q: Does Icare HOME qualify as a device for RPM?
A: Yes. In March, 2017, the Food and Drug Administration, under its 510(k) regulations, cleared the Icare HOME for marketing in the U.S.5
Q: What CPT codes apply to RPM?
A: In 2019, CPT added three new procedure codes to report various aspects of RPM:
99453 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
99454 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
99457 – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month
Significantly, the 20 minute requirement is cumula-tive throughout the month of physician and staff time. Although not explicitly stated in CPT, it assumes 15 minutes of work by the billing practi-tioner per month.4
Q: Does Medicare cover RPM?
A: Yes. Effective January 1, 2019, CMS incorporated coverage and payment of RPM in the Medicare Physician Fee Schedule.6 This represents a favorable shift in Medicare policy compared with prior years.
Q: What does Medicare allow for RPM?
A: In 2019, the national Medicare Physician Fee Schedule allowable amounts, in-office, are:
99453 $19 (reported only once per episode of care; do not report for monitoring of less than 16 days)
99454 $64 (report once at the end of each month; do not report for monitoring of less than 16 days)
99457 $52 (report once each 30 days, regardless of the number of parameters monitored)
The payment amounts are adjusted by local wage indices. Like most Medicare covered services, these amounts are subject to annual deductibles and copayments.
Q: What level of supervision does RPM require?
A: Ophthalmic technicians or medical assistants are an important part of RPM for patient training on use of the Icare HOME, collection of IOP data, scheduling monthly follow-up phone calls, helping coordinate care with other providers, and answering basic questions about treatment such as how to instill eye drops. Because there is no separation of technical and professional components for RPM, the MPFS designates “9” for CPT 99453, 99454, and 99457 meaning the “supervision concept does not apply”, so we infer that these services are furnished under the physician’s control as would be the case for general supervision.
Q: What chart documentation is required to support these codes?
A: IOP monitoring using RPM is only recommended by an ophthalmologist or optometrist after a thorough eye exam. A detailed, written explanation is provided to the patient with a provision to stop RPM at any time. A structured chart note is used to record the IOP data, interpreta-tion, and physician treatment plan. The staff follow a billing protocol consistent with CPT instructions (i.e., per episode for 99453, monthly for 99454 and 99457).
Q: Are there code bundles or limitations?
A: CPT code 99457 cannot be reported in conjunction with 99091 (Collection and interpretation of physiologic data). Also, 99457 cannot be report on the same day as an eye exam. Lastly, chronic care management (99490 or 99491) and 99457 are complementary services, but time spent performing these services should remain separate and not be counted twice. In our view, it is likely that the ophthalmologist or optometrist would prefer to work with the chronic care management physician (assuming there is one) and not as the chronic care management physician.
 Mudie, L, LaBarre, S, et al. Clinical Performance Study for Self-use of an Intraocular Pressure Measuring Device: the Icare Home Device (TA022). Annual meeting of the American Glaucoma Society. March 2016
Provided Courtesy of Icare USA, Inc. (888) 422-7313
Last updated September 1, 2019
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over
time, and may be incorrect at any time following publication.
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