Coding description of 99091
CPT code 99091; Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
A physician or other qualified health care professional collects and interprets physiologic data. The data (e.g., blood pressure) is stored digitally and may be transmitted by the patient and/or the caregiver to the provider. The report should contain the time it took the provider to acquire the physiologic data, review and interpret the data, and modify any care plan due to the additional data acquisition. A minimum of 30 minutes every 30 days must be spent in the collection and interpretation of data to report this service.
Coding description of CPT code 99091
When there are instructions specific to a code or range of codes in the guidelines, parenthetical instructions, or code descriptors, the specific time measurement listed should apply, instead of the general midpoint time rule. This instruction is further reinforced by the following statement in the Time subsection of the Introduction section of the CPT code set:
The CPT code set contains many codes with a time basis for code selection. The following standards shall apply to time measurement, unless there are code or code range–specific instructions in the guidelines, parenthetical instructions, or code descriptors to the contrary.
In addition to the corrections and clarifications noted above, it is important to note that code 99091 was resequenced and moved from the Medicine section to the Evaluation and Management (E/M) section in the CPT 2019 code set, as follows:
Digitally Stored Data Services/Remote Physiologic Monitoring
Code 99091 was resequenced and moved from the Medicine/Miscellaneous subsection to the E/M/Non-Face-to-Face Services subsection/Digitally Stored Data Services/Remote Physiologic Monitoring subsection to align with the appropriate family of codes and reflect current practice for these services. The descriptor language was also revised to specifically state that this code should be reported only once per 30 days. Code 99090 was deleted due to low utilization.
CMS will reimburse for professional time dedicated to monitoring services and does not require interactive communication like 99457 to bill. However, it requires a physician or other QHP to perform these services, and requires 30 minutes of time every 30 days to bill. 99457 and 99091 cannot be billed concurrently. The average national Medicare payment for these services is $58.38.
If the services described by code 99091 are provided on the same day the patient presents for an E/M service, these services should be considered as part of the E/M service and should not be reported separately
Do not report CPT code 99091 with CPT code 99457
Do not report CPT code 99091 if it occurs within 30 days of 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380, 99457
Example of CPT cope 99091
A 67-year-old male with labile diabetes is utilizing a home glucose-monitoring device to capture multiple glucose readings during the course of a month in association with daily data of symptoms, medication, exercise, and diet. The data are transmitted from the home computer to the physician’s office by email, downloaded by the physician, and the data are reviewed.
The physician or QHP reviews, interprets, and reports the data digitally stored and/or transmitted by the patient. At least one communication (eg, phone call or email exchange) with the patient to provide medical management and monitoring recommendations takes place.