The clinical setting may not be the best place to get an accurate blood pressure reading, and two new CPT® 2020 codes are here to help. Medical codes 99473 and 99474 apply to self-measured blood pressure services. Here’s what you need to know.
1. Review the Codes and Descriptors
Getting to know any new codes starts with a careful review of their descriptors. The two new codes represent different services:
- Training/calibration: 99473 (Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration)
- Data collection/report: 99474 (… separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient)
Both codes state that services are related to self-measured blood pressure. Also note that the device involved must be validated for clinical accuracy.
Code 99473 represents the work of training the patient and calibrating the device.
Code 99474 may be easier to understand if you look at the descriptor components as bullets:
- Separate self-measurements of two readings one minute apart
- Twice daily over a 30-day period
- Minimum of 12 readings
- Collection of data reported by the patient/caregiver to the physician/other qualified health care professional
- Report of average systolic and diastolic pressures
- Subsequent communication of a treatment plan to the patient
2. Check for New Guidelines and Parenthetical Notes
The CPT® notes for the new codes cover frequency of reporting and refer to similar codes you should be careful not to report with 99473 and 99474.
Frequency: Under 99473, you’ll find an important note that you should not report this code, which covers training and calibration, more than once per device.
Under collection and reporting code 99474, there’s a note that you should not report the code more than once per calendar month. Remember both this line and the “30-day period” text from 99474’s descriptor when you’re scheduling this service.
Keep these codes separate: Under 99473, there is another note pointing you to these revised codes for ambulatory blood pressure monitoring: 93784 (recording, scanning analysis, interpretation, report), 93786 (recording), 93788 (scanning analysis and report), and 93790 (review, interpretation, report). Those codes relate to an automated cuff system that creates its own report.
Those revised codes appear in another note telling you to not report 99473 and 99474 in the same calendar month as these codes:
- Ambulatory blood pressure monitoring: 93784, 93786, 93788, 93790
- Remote monitoring of physiologic parameters: 99453, 99454
- Physiologic data collection and interpretation, 30 minutes or more every 30 days: 99091
- Remote physiologic monitoring treatment management services: 99457
- Chronic care management services: 99487, 99489, 99490, 99491
Bonus E/M rule: A new guideline before the codes lets you know that if 99474 services “are provided on the same day the patient presents for an evaluation and management (E/M) service to the same provider, these services should be considered part of the E/M service and not reported separately.”
3. Expect Medicare Payment for Both Codes
The Medicare Physician Fee Schedule (MPFS) lists both 99473 and 99474 as active codes and provides relative value units (RVUs) for both.
Code 99473 for training and calibration has 0.31 total RVUs for a national payment rate of $11.19 in both the facility and nonfacility settings.
Code 99474 has 0.42 total nonfacility RVUs for a national Medicare rate of $15.16. At 0.25 total facility RVUs, the MPFS facility rate is lower at $9.02. That’s because the practice expense RVUs are lower on the MPFS for the facility setting. (In other words, the physician doesn’t bear as much expense in the facility setting and therefore the physician’s reimbursement is lower for services performed in the facility setting.)
4. Improve Reporting by Knowing the Rationale
According to a presentation at the American Medical Association (AMA) CPT® and RBRVS 2020 Annual Symposium, the United States Preventive Services Task Force (USPSTF) has updated its recommendations for screening for high blood pressure. In the clinical setting, there are a small number of measurements and patients may be nervous, which could lead to inaccurate results for blood pressure measurement. The USPSTF has stated that blood pressure monitoring outside of the office is effective for confirming hypertension. The new codes 99473 and 99474 offer a way to report the work involved for this approach.
Tip: Check out the TARGET: BP page about patient-measured blood pressure by the American Heart Association and American Medical Association for helpful resources to get started.
What About You?
Do you expect to use these new codes for self-measured blood pressure monitoring?