AMA's coding panel stalled a decision to diversify remote monitoring codes—again

The American Medical Association’s (AMA's) CPT Editorial Panel, which is responsible for creating medical billing codes, again forfeited an opportunity to move forward with remote patient monitoring billing code reform, three sources told Fierce Healthcare. One source considers the changes “dead.”

The coding panel met May 9-11 in Chicago for its tri-annual discussion of CPT code change applications submitted by outside parties. For several consecutive meetings, the panel has received code change applications to change a portion of remote physiologic monitoring and remote therapeutic monitoring codes. 

If the panel agrees to a code, it gets priced by AMA’s Specialty Society RVU committee. The codes can then be used by insurers and providers.

In its past several meetings, the code change application for remote monitoring has been withdrawn by the applicant before the start of the meeting, due to internal politics of the panel.

In its last meeting in February 2024, the remote monitoring code change application was withdrawn just two days before the meeting began after a discussion between stakeholders and the panel where agreement on the code changes was split among stakeholders. A decision was punted to May.

The remote monitoring code change application successfully made it into the May coding panel meeting and was discussed by the panel. Sources say the talks were going well until the panel fell into disagreement. One source called the discussion “tense.”

The panel decided to indefinitely postpone talks of the code changes. One source involved in the meeting said they hope the panel will re-up the discussion in its September meeting, but another involved party considers it “dead.” 

The remote monitoring code change application would have offered two different billing options for remote monitoring based on how many days of data were collected. One would have allowed billing for 2-15 days’ worth of data collection, lowering the threshold for payment. The second would have maintained the status quo of remote monitoring billing and paid for 16-30 days’ worth of data collection, likely with higher reimbursement. 

The application also would have changed device supply codes for RPM and RTM. 

The House Energy and Commerce health subcommittee passed a bill yesterday that would lower the data reporting threshold for remote monitoring down to two days. Some say that doing so would result in worse quality of care for patients, while others believe 16 days’ worth of data is not necessary for some conditions. They say the data reporting requirement is burdensome for providers.

The bill will advance to a full committee vote.