What is Digital Evaluation and Management?
Online Digital Evaluation and Management Services (CPT codes 99421, 99422, and 99423): In the CY 2020 PFS final rule (84 FR 62797), we finalized payment for new online digital assessment services, also referred to as “E-Visits,” beginning in CY 2020 for practitioners billing under the PFS. These services are non-face-to-face, patient-initiated communications using online patient portals. These digital assessment services are for established patients who require a clinical decision that otherwise typically would have been provided in the office.
Components of Implementing CCM
Patient Consents & Initial Setup
Acquire consent from the patient to be remotely monitor (Verbal and written(Annually)
Enroll Requirements
Services can only be issued for established patients only
Monitoring Data and Billing
Supply continuity of care thru care members and submit billing for reimbursement
The Workflow
Plan
Create a Digital E/M work-flow, establish documentation, and billing procedure
Train
Train qualified clinical staff to help remote monitor patients vitals.
Consent
Acquire consent from the patient to be remotely monitor
Educate
Educate patients on how to measure oxygen and blood pressure health data using Connect+ to collect health data
Sync
Patient sync and health data remotely monitor by physician/clinical staff
Submit
Submit eligible patients for billing and get reimbursed for monthly monitoring.
Digital Evaluation and Management Pathway
Digital E/M CPT Billing Code Guide
CPT 99421
Digital Evaluation and Management Monitoring-
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes.
CPT 99422
Digital Evaluation and Management Monitoring-
Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11-20 minutes.
CPT 99423
Digital Evaluation and Management Monitoring-
Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11-20 minutes.
Frequently Ask Questions
How often should you report these codes?
CPT codes 99421, 99422, and 99423 are reported once during a 7-Day period for the cumulative time.
Does the patient need to initiate digital evaluation services?
Yes. The patient initiates the service with an inquiry through the portal.
Can Clinical staff time be included for the evaluation management service?
No, Physicians and Nurse Practitioners can bill for 99421, 9422, and 99423 CPT Codes.
If the inquiry is about a problem addressed at the E/M service in the past 7 days, can these codes be billed
No. The inquiry must be regarding a new problem that has not been addressed in the past 7 days period of E/M services, then services can be billed.