Key result
Second-generation RPM codes are associated with ~10% fewer sleep-wake disorders versus first-generation codes.
Why the study?
The use of remote patient monitoring services for neurological disorders remains understudied, especially regarding newer billing codes introduced before the COVID-19 pandemic.
How do patient and encounter characteristics differ between first- and second-generation remote patient monitoring billing codes for neurological disorders?
Cohort (n=11,326)
Yes
How do patient and encounter characteristics differ between first- and second-generation remote patient monitoring billing codes for neurological disorders?
Absolute Event Rate: 87.9% vs 97.5%
p-value: p=<0.001
In a commercially insured population receiving remote patient monitoring for neurological disorders, sleep-wake disorders and non-neurologists were over-represented, with significant demographic differences between first- and second-generation billing code cohorts.
Demographic shifts between RPM cohorts warrant adjustment in outcome studies; leaves open questions of access equity and generalizability in neurological monitoring.
Introduction : The use of remote patient monitoring (RPM) services for neurological disorders remains understudied, particularly in the context of newer billing codes introduced before the COVID-19 pandemic. Methods : This retrospective cohort study utilized data from commercial and Medicare employer-sponsored administrative claims between January 1, 2019, to December 31, 2021. The study population included all patients with at least one qualifying RPM-related Current Procedural Terminology (CPT) code for a neurological disorder, separated into first-generation (CPT 99091) codes and second-generation (CPT 99453, 99454, 99457, 99458) code cohorts. We compared patient and encounter characteristics between both cohorts. Results : We identified 27,756 encounters attributable to 11,326 patients who received RPM services for neurological disorders, of whom 5,785 (51.1%) received RPM via second-generation billing codes, 3,941 (34.8%) were female, 6,712 (59.3%) were between 45 and 64 years old, and 10,488 (92.6%) had a primary diagnosis of sleep–wake disorder. The second-generation cohort was significantly more likely to be female (41.5% vs. 27.8%, p < 0.001), be of age 65 or older (15.7% vs. 7.1%, p < 0.001), and reside in urban areas (93.4% vs. 87.6%, p < 0.001) than the first-generation cohort. Patients in the second-generation cohort were more likely to receive RPM in office settings (86.3% vs. 62.5%, p < 0.001), by physicians (77.0% vs. 40.3%, p < 0.001), and less likely for sleep–wake disorders (87.9% vs. 97.5%, p < 0.001) than the first-generation cohort. Patients who received RPM from physicians were most often evaluated by pulmonologists (31.4%). Discussion : In this commercially insured patient population receiving RPM for neurological disorders, we found that sleep–wake disorders and non-neurologists were over-represented.
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Hwang et al. (2024) conducted a cohort in Neurological disorders (n=11,326). Second-generation RPM billing codes (CPT 99453, 99454, 99457, 99458) vs. First-generation RPM billing codes (CPT 99091) was evaluated on Primary diagnosis of sleep-wake disorder (p=<0.001). Patients billed with second-generation remote patient monitoring codes for neurological disorders were less likely to have sleep-wake disorders than those with first-generation codes (87.9% vs 97.5%, p<0.001).
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