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Coding Corner: Capture reimbursement for self-measured blood pressure

March 12, 2020
Area(s) of Interest: Practice Management 


CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from Deborah Marsh, senior development editor for AAPC, a training and credentialing association for the business side of health care.

The CPT® 2020 code set added two new codes for self-measured blood pressure (SMBP), effective January 1, 2020. Medicare covers both codes, so don’t miss your chance to be reimbursed for these services.

99473 applies to training and calibration
You’ll use the first new SMBP code to represent calibrating the device and training the patient to use it.

99473 Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration

You should report 99473 only once per device, according to a parenthetical note with the code in the CPT® code set.

99474 applies to data collection and report
The second SMBP code covers the remaining work from measurement to treatment plan. The descriptor includes a long list of requirements, so review it carefully.

99474 Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient

Note that the descriptor refers to a 30-day period, but a parenthetical note under the code instructs you not to report 99474 more than once per calendar month. Keep these time periods in mind when scheduling and reporting the services.

Don’t report 99473 and 99474 along with these codes
Before you submit 99473 and 99474, you also need to be aware that CPT® instructs you not to report those codes in the same calendar month as the codes for these services:

  • Ambulatory blood pressure monitoring: 93784, 93786, 93788, 93790
  • Remote monitoring of physiologic parameters: 99453, 99454
  • Physiologic data collection and interpretation, 30 minutes or more every 30 days: 99091
  • Remote physiologic monitoring treatment management services: 99457
  • Chronic care management services: 99487, 99489-99491

CPT® guidelines also state that if 99474 services “are provided on the same day the patient presents for an evaluation and management (E/M) service to the same provider, these services should be considered part of the E/M service and not reported separately.”

Collect roughly $9-$15 per service
The Medicare Physician Fee Schedule (MPFS) for the first quarter of 2020 classifies 99473 and 99474 as active codes.

For training and calibration code 99473, the national MPFS payment rate is $11.19 in both the facility and nonfacility setting.

For the data collection and reporting code, 99474, the rate varies depending on the setting. In the nonfacility setting, the national rate is $15.16. In the facility setting, the national rate is $9.02. For many services, Medicare reimburses physicians less in the facility setting because the expectation is that the facility bears some of the expense.

Remember that the final fee will depend on other factors, including adjustment for geographic location.

Learn more about SMBP
The American Medical Association (AMA), which maintains the CPT® code set, has stated that 99473 and 99474 better align with current clinical practice and expand reporting options for physicians who care for patients with different levels of access to care.

Plus, the small number of measurements collected in the clinical setting, along with patient nervousness, can lead to inaccurate results for blood pressure measurement. Blood pressure monitoring outside of the office is effective for confirming hypertension, according to the United States Preventive Services Task Force.

If your practice provides these SMBP-related services, or would like to, review the TARGET: BPTM page about patient-measured blood pressure by the American Heart Association and AMA. You’ll find information about how SMBP works and guidance on launching an SMBP monitoring program.

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