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Channel your tech savvy and prepare for a flight into the digital future now that CMS has loosened the reins on telehealth services for Medicare Advantage (MA) carriers in 2020.


A proposed new national coverage determination (NCD) on ambulatory blood pressure monitoring (ABPM) may open up this service to a whole new subset of your patients – but also requires some investment on your part.


You’ll soon find a reprieve when you turn to modifier 59 (Distinct procedural service) because you will be eligible to append the modifier to either code in a Correct Coding Initiative (CCI) bundled pair, CMS announced in a Feb. 15 transmittal.


Question: In the “Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household” section of the Medicare Policy Manual, CMS lists several categories of persons whose treatment cannot be billed to Medicare when the related provider treats them. But if a doctor who is not related to me supervises my treatment, but the NPP who actually performs the treatment incident-to is related to me, can the doctor charge for that? Also, if I’m the spouse of one of the doctors in a practice, are all the doctors in that practice prohibited from charging for my treatment?

Cardiologists, internal medicine providers and nephrologists are the most likely specialty groups to report a series of ambulatory blood-pressure monitoring codes that, ultimately, don’t get much attention.


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