Under the new revision, remote patient monitoring (RPM) CPT codes 99091, 99453, 99454, 99457, and 99458 will be payable. Specifically, MassHealth will provide RPM coverage for members who meet certain clinical criteria, including "perinatal state," which is defined as the period encompassing pregnancy, labor, and delivery, through 12 months following delivery, inclusive of all pregnancy outcomes.
These criteria are exemplary in their expansiveness, and can provide a template for commercial payers in Massachussetts (and other payer programs across the US) as they develop their own maternal RPM reimbursement policies.
While the guidance (found here) directs providers to identify one or more risk factors that warrant the use of RPM, and offers a detailed list of possible risk factors, the list is non-exhaustive. Clinicians are empowered to use their judgment in terms of assessing and identifying risk, including a consideration of social and demographic factors -- an inclusion that represents a positive step toward a more comprehensive definition and treatment of maternal risk.
These new policies are likely to have a significant impact on maternal health outcomes, as claims-based models offer a cost-effective way for practices to support proven RPM solutions for their patient populations.
Among other benefits, practices will now be reimbursed for technology for blood pressure monitoring. This will be especially effective for addressing hypertensive disorders of pregnancy (HDP), which are some of the leading causes of adverse maternal health outcomes and linked to longterm cardiovascular issues. ACOG and others have recommended continuous blood pressure monitoring in the prenatal and postpartum period as a means to identify and manage HDP, but this heightened surveillance results in additional outpatient appointments throughout the pregnancy, placing a considerable strain on both the patient and the healthcare system.
RPM for blood pressure (BP) offers an efficient and cost-effective way to align with this guidance without placing undue stress on the provider and patient. With Babyscripts' RPM model, for example, the patient can record their blood pressure levels in the comfort and convenience of home, with the assurance that an alert will be sent to their provider in the event of a reading that falls outside a normal threshold.
Remote BP monitoring has demonstrated improved accuracy and enhanced data quality (especially as it circumvents the issue of white coat syndrome, which can nullify in-clinic readings). Moreover, in pregnant populations, various studies have shown that remote monitoring is not only feasible but also potentially favorable compared to conventional clinic monitoring.
The implementation of RPM coverage by MassHealth marks a transformative step in maternal healthcare, and should set a precedent for other payer programs across the nation. By acknowledging the importance of continuous and comprehensive care for pregnant and postpartum women, this policy empowers clinicians to seek out innovative, cost-effective solutions to better manage their maternal populations. With more policy changes like this, we can hope to see widespread RPM adoption and better maternal health outcomes across the US.