Isabella Carter
CPT code 99091 refers to the time spent by a physician or other qualified health care provider on remote patient monitoring services. According to the American Medical Association (AMA), a qualified healthcare professional (QHP) is an individual qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable). This includes physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives. CPT code 99091 specifically covers the collection and interpretation of physiologic data, such as ECG, blood pressure, and glucose monitoring, which is digitally stored and/or transmitted to the physician or QHP. This code requires a minimum of 30 minutes of time every 30 days and is reimbursed by the Centers for Medicare and Medicaid Services (CMS) as part of their remote patient monitoring (RPM) program.
| Characteristics | Values |
|---|---|
| CPT Code | 99091 |
| Description | Non-face-to-face services, digitally stored data services/remote physiologic monitoring |
| Qualified Health Care Professionals | Physicians, nurse practitioners, physician assistants, certified nurse specialists, certified nurse midwives |
| Reimbursement | Reimbursed under CPT codes for work pertaining to remote physiologic monitoring, including medical intervention, care coordination, and patient interaction |
| Time Requirements | Requires at least 30 minutes of time every 30 days |
| Clinical Staff | Clinical staff time, including time spent providing care management services, cannot be counted for non-QHPs |
| Billing | CPT code 99457 and 99091 cannot be billed in conjunction with each other |
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What You'll Learn
- A qualified health professional is defined by the American Medical Association (AMA) as an individual qualified by education, training, licensure/regulation, and facility privileging
- Physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives are examples of qualified health professionals
- Clinical staff members work under the supervision of a physician or other qualified healthcare professional
- Non-QHPs cannot claim time spent by clinical staff, even if they are providing care management services
- CPT code 99091 refers to time spent by a physician or other qualified health care provider on remote patient monitoring services
A qualified health professional is defined by the American Medical Association (AMA) as an individual qualified by education, training, licensure/regulation, and facility privileging
The American Medical Association (AMA) defines a qualified health professional as an individual qualified by education, training, licensure/regulation, and facility privileging. This definition was established in 2013 to provide clarity on which providers may report medical services. According to the AMA, a qualified health professional, also known as a QHP or "physician or other qualified health care professional," is an individual who possesses the necessary education and training to perform professional services within their scope of practice. This includes individuals such as physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives.
Education and training are essential components of becoming a qualified health professional. Accreditation plays a crucial role in ensuring that educational programs meet professional standards and prepare students for their future roles. Vocational schools, colleges, and universities offer programs that provide the necessary knowledge and skills for individuals to become qualified health professionals. Additionally, continuing education requirements help professionals stay up-to-date with the latest advancements and changes in their field.
Licensure and regulation are also critical aspects of qualification. While specific requirements may vary across states and specialties, licensure serves as a validation of an individual's competency and knowledge. Regulatory boards establish education requirements and determine the scope of practice for different healthcare professions. Licensure provides assurance to employers and the public that a health professional has met the necessary standards and is authorized to practice within their scope.
Facility privileging is another factor in defining a qualified health professional. This refers to the granting of specific practice rights and responsibilities to an individual by a healthcare facility. It involves evaluating an individual's qualifications, competence, and performance to determine their eligibility to provide patient care within a particular facility. Facility privileging ensures that health professionals are authorized to practice in specific settings and are accountable to the facility's standards and policies.
It is important to distinguish qualified health professionals from clinical staff. Clinical staff members work under the supervision of physicians or qualified health professionals and assist in performing specified professional services. They do not individually report those services and their roles are defined by law, regulation, and facility policy. The scope of practice for both qualified health professionals and clinical staff may vary depending on state laws, local regulations, and payer-specific policies.
In conclusion, the American Medical Association's definition of a qualified health professional encompasses individuals with the necessary education, training, licensure/regulation, and facility privileging to independently perform professional services within their scope of practice. This definition provides a framework for determining qualification and ensures that healthcare providers meet the required standards to deliver quality patient care.
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Physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives are examples of qualified health professionals
Physicians, often referred to as doctors, typically possess a medical degree and are licensed to practice medicine. They are responsible for diagnosing and treating illnesses, prescribing medications, and providing comprehensive care to patients. Physicians often work in collaboration with other healthcare professionals to ensure optimal patient outcomes.
Nurse practitioners (NPs) are advanced practice registered nurses who have undergone specialized education and training. They serve as primary and specialty care providers, delivering advanced nursing services. NPs can work independently, prescribe medications, and order laboratory tests. They often collaborate with physicians and other health professionals to provide holistic care to patients and their families.
Physician assistants (PAs) work under the supervision of physicians and are trained to provide supportive medical services. They may examine patients, diagnose illnesses, develop treatment plans, and perform certain medical procedures. PAs often work in collaboration with physicians and other healthcare professionals to ensure effective patient care.
Certified nurse specialists (CNSs) are advanced practice registered nurses who possess specialized knowledge and skills in a particular area of nursing. They may focus on specific patient populations, such as pediatrics or geriatrics, or on certain conditions or specialties, such as oncology or critical care. CNSs often work alongside physicians and other nurses to improve patient outcomes and enhance the quality of care.
Certified nurse midwives (CNMs) are advanced practice nurses who provide specialized care for women throughout their lives, including gynecological exams, prenatal care, labour and delivery, and postpartum care. They may also provide primary maternity care, family planning services, and wellness education. CNMs are trained to manage emergency situations and often work in collaboration with physicians during complex cases, such as cesarean births.
These qualified health professionals play integral roles in the healthcare system, contributing their expertise and skills to meet the diverse needs of patients. Their scope of practice may vary depending on state regulations and the specific requirements of their roles, but they all share a common goal of promoting health and well-being through their dedicated service.
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Clinical staff members work under the supervision of a physician or other qualified healthcare professional
Qualified healthcare professionals (QHPs), as defined by the American Medical Association (AMA), are individuals qualified by education, training, licensure or regulation, and facility privileging. They perform professional services within their scope of practice and independently report those services. Physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives are examples of qualified healthcare professionals who may bill evaluation and management codes using CPT code 99091.
It is important to note that clinical staff time, including care management services, cannot be counted for non-QHPs. The CPT codebook defines a clinical staff member as an individual who works under the supervision of a qualified healthcare professional and is allowed by law and facility policy to perform or assist in specified professional services without individually reporting those services. The specific personnel who qualify as "clinical staff" can vary depending on state law, medical boards, local regulations, and facility policies, including training and education requirements.
Remote patient monitoring (RPM) programs have gained popularity, especially with advancements in technology and increased adoption during the COVID-19 pandemic. CPT codes, such as 99091, provide reimbursement for remote monitoring services, allowing providers to bill for their time spent on remote physiologic monitoring, medical intervention, care coordination, and patient interaction. These codes are essential for managing patients with chronic illnesses and various other conditions.
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Non-QHPs cannot claim time spent by clinical staff, even if they are providing care management services
CPT code 99091 refers to time spent by a physician or other qualified health care provider on remote patient monitoring services. Non-QHPs cannot claim time spent by clinical staff, even if they are providing care management services.
A qualified healthcare professional (QHP), according to the American Medical Association (AMA), is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable). They must also perform a professional service within their scope of practice and independently report that professional service. This means that CPT code 99091 cannot be claimed by non-QHPs, even if they are providing care management services.
The CPT Codebook defines a clinical staff member as someone who works under the supervision of a physician or other qualified healthcare professional. They are allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but they do not individually report that service. The type of personnel that qualify as “clinical staff” for remote patient monitoring (RPM) varies by state law, state medical boards, local regulations, and facility policy.
RPM-specific CPT codes reimburse providers for RPM services, and CPT code 99091 is for the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted to the physician or QHP by the patient and/or caregiver. This code requires at least 30 minutes of time every 30 days.
It is important to note that CPT code 99091 cannot be billed in conjunction with CPT code 99457, according to the American Medical Association CPT Manual. However, CMS stated in the 2021 Medicare Physician Fee Schedule that billing both codes simultaneously may be appropriate in some instances.
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CPT code 99091 refers to time spent by a physician or other qualified health care provider on remote patient monitoring services
CPT code 99091 refers to the time spent by a physician or other qualified health care provider on remote patient monitoring services. It is one of the CPT codes that providers can use to get reimbursed for providing remote monitoring services. CPT code 99091 specifically refers to the collection and interpretation of physiologic data, such as ECG, blood pressure, and glucose monitoring, that is digitally stored and/or transmitted to the physician or other qualified healthcare professional. This code requires at least 30 minutes of time every 30 days.
According to the American Medical Association (AMA), a qualified healthcare professional (QHP) is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable). They perform professional services within their scope of practice and independently report that service. Physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives are all examples of qualified health care providers who may bill CPT code 99091.
It is important to note that clinical staff time, including time spent providing care management services, cannot be counted for non-QHPs. Additionally, CPT code 99091 cannot be billed in conjunction with CPT code 99457, according to the CPT Manual. However, in some instances, it may be appropriate to bill these codes simultaneously, as stated by CMS in the 2021 Medicare Physician Fee Schedule.
CPT code 99091 is used for remote patient monitoring (RPM) programs, which have grown in popularity in recent years due to the COVID-19 pandemic, technological advancements, and increased adoption among hospitals, care coordinators, physicians, and patients. RPM is often used to manage patients with chronic illnesses such as diabetes, obesity, hypertension, and heart failure, but it can also be used to treat a variety of other conditions.
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Frequently asked questions
CPT code 99091 refers to the time spent by a physician or other qualified health care provider on remote patient monitoring services.
According to the American Medical Association (AMA), a qualified healthcare professional (QHP) is an individual qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable). They perform professional services within their scope of practice and independently report that service.
CPT code 99091 can be reported by physicians, nurse practitioners, physician assistants, certified nurse specialists, and certified nurse midwives.
CPT code 99091 covers the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted to the physician or QHP by the patient and/or caregiver. This requires at least 30 minutes of time every 30 days.
No, clinical staff time, including time spent providing care management services, cannot be counted for non-QHPs.
