Wiki Provider Charge Question

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REllington11

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I work for Endocrinologists and one doctor presented question concerning if billing is allowed and I am not sure. The scenario: Many patient call concerning medication or CGM settings for our patients especially Diabetics. Many patient send in Blood Sugar Logs or CGM reports every few weeks. The doctor then reads and interprets if any change in medication or settings on Insulin pumps/CGM are needed. The doctor then tells their MA's to relay the message to the patient. The doctor feels that they should be able to charge for their time and expertise. One doctor suggested using CPT codes 99453 & 99454 but CPT Code 99453 is described as the initial set-up and provision of training or education to patients on how to use the medical device(s) while CPT Code 99454 may be utilized to report the supply of the medical device(s) for health data alert transmissions. I do not think this applies. I thought maybe the Non-Physician phone call (98966 - 98968) but does this apply to MA's and does not include physicians time. Is there any suggestions? I would appreciate any suggestions. Thank you all for your help


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Maybe one of these would help? https://pro.aace.com/cgm/toolkit/billing-codes

Have you looked at 99091: The provider interprets medical information, such as ECG recordings, blood pressure records, and home glucose monitoring results, received in digital form from a patient or his caregiver requiring at least 30 minutes of the provider’s time. A physician or other qualified healthcare professional may report this code once each 30–day period.

or looked at 95251?
 
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Forgot also: https://provider.dexcom.com/coding

"What type of healthcare provider/physician can bill and perform CPT codes 95249, 95250 and 95251?
CPT codes 95249 and 95250 do not have any physician work RVUs (Relative Value Units); therefore, the associated services can be performed by a trained RN, PharmD/RPh, RD, CDE or MA (if within their scope of practice) and billed by the supervising physician advanced practitioner or hospital outpatient department. However, only providers such as Physician (MD), Nurse Practitioner (NP), Physician Assistant (PA) or Clinical Nurse Specialist (CNS) can perform and bill for services associated with CPT code 95251."
 
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