The variety and number of wearable health tech devices are increasing rapidly, but what about medical care or supervision, especially for people with chronic conditions? Interpreting measurements and reports in many cases requires the trained, knowledgeable input of healthcare professionals. Few physicians in the U.S. make house calls and no individual or insurance company wants to turn out their pockets to pay for ambulance rides or even tie up medical office resources for routine and progress checks, but many have assumed that chronic care patients require inevitable, expensive office visits, sometimes including the cost of ambulance transfer. The promise of remote devices is that essential measurements often can be taken and monitored remotely but most have assumed that if patients don’t go to the office or hospital there’s no insurance coverage. That was true until the end of 2014.
In some cases you can be covered and the healthcare provider can be paid for remote care. As of January 1, 2015, the new Medicare code 99490 allows for Medicare and Medicaid coverage for remote chronic care management under very specific conditions. Coverage is available and pays up to $40 per month for at least 20 minutes of care by clinical staff when there are two or more chronic, long term conditions (“long term” meaning at least 12 months or until death), the chronic conditions have a risk of death, acute worsening, or “functional decline,” and there is a comprehensive care plan established, implemented, revised or monitored.
Medicare code 99490 doesn’t mean your doctor will be reimbursed for chatting remotely with you about your FitBit numbers or even discussing patterns or reports from a prescribed monitoring or treatment device, but the if your condition and care match the specified conditions, insurance coverage may be available, which could mean less time, aggravation, and possible discomfort for patients and a lessened financial impact on health system resources.