Renee Kinder

Observe a therapist for a day and you will likely note among their communication is full of alphabet soup and acronyms.

ICD-10, CPT, HIPPS, CGA, PDPM, DRG, GERD, HIPAA… and the list goes on and on.

These terms are a reflection of regulation, metrics and clinical conditions with understanding of their meanings being acquired throughout our training and career.

They are essential for day-to-day practice.

DMPAG & TCET are two new acronyms for therapists to learn this year. 

By learn, I mean I would recommend therapists not only appreciate their current meaning, but also that they attend to the evolution of their meaning as there is significant potential for these two acronyms to change medical practice and subsequently the way we care for patients daily. 

Let’s start with DMPAG, or the Digital Medicine Payment Advisory Group (DMPAG)

DMPAG is a collaborative initiative — convened by the American Medical Association (AMA) — that engages a diverse cross-section of nationally recognized experts. 

Background on DMPAG and impact of CPT coding

To begin, as noted by the AMA, digital medicine presents an opportunity to improve access and to offer cost-effective medical care to a large swath of patients with varied needs. 

In order to maximize this potential, over the past several years, the CPT® Editorial Panel has made significant progress in establishing CPT codes for digital medicine services.

Increasing coverage requires a concerted effort by knowledgeable professionals, as well as input, such as pertinent use cases and clinical data that demonstrate the efficiencies and clinical benefits of digital medicine. 

Hence the need for and creation of DMPAG.

What are the focus areas of DMPAG? 

  • Create and disseminate data supporting the use of digital medicine technologies and services in clinical practice.
  • Review existing code sets (with an emphasis on CPT and HCPCS) and determine the level to which they appropriately capture in current digital medicine services and technologies.
  • Assess and provide clinical guidance on factors that impact the fair and accurate valuation for services delivered via digital medicine.
  • Provide education and clinical expertise to decision makers to ensure widespread coverage of digital medicine (e.g., telemedicine and remote patient monitoring), including greater transparency of services covered by payers and advocacy for enforcement of parity coverage laws.
  • Review program integrity issues including, but not limited to, appropriate code use, and other perceived risks unique to digital medicine. Develop guidance and clarity on issues to diverse stakeholder groups.

What are some current coding highlights from DMPAG, you ask?

Remote monitoring: To address broader remote monitoring use cases, the DMPAG worked with the CPT Editorial Panel in creating remote physiologic monitoring codes. This initial set of codes became effective in 2019, and in 2020 an additional code was created to report additional physician/QHP time related to remote monitoring.

Online digital visits (e-visits): These services are the kind of brief check-in services furnished using communication technology that are employed to evaluate whether an office visit or other service is warranted. This is often done through a patient portal or smartphone. Each code specifies the amount of time spent during the online evaluation of a patient.

Interprofessional internet consultations: The CPT code set has several codes to allow the reporting of electronic, non-verbal communication between consulting and treating/requesting physicians. While codes currently exist to report verbal and written reports, no codes previously existed to report the sending of results without additional verbal communication.

Telephone evaluation and management services: CPT codes to describe telephone evaluation and management services have been available since 2008. Relative values are assigned to these services. Medicare still currently considers these codes to be non-covered. However, private payers may pay for these services. Each corresponding code describes the amount of time of medical discussion.

(Note: CPT® is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.)

Also of note, while not all areas above are immediately accessible to therapy teams’ awareness is important here. We often see an evolution of care and practice which begins with physicians. 

Additionally, as members of a holistic IDT, it is essential that we understand all of the care options for those we serve. 

For this reason, above all others, therapists having an understanding of DMPAG is vital in 2022 and rule making years ahead of us. 

Now moving on to our second acronym for therapists: Transitional Coverage for Emerging Technologies (TCET).

We were first introduced to this concept in a November 2021 press release from CMS titled: CMS Repeals MCIT/R&N Rule; Will Consider Other Coverage Pathways to Enhance Access to Innovative Medical Devices.

WIthin this press release the following was noted:

“CMS intends to explore coverage process improvements that will enhance access to innovative and beneficial medical devices in a way that will better suit the health care needs of people with Medicare. This will also help to establish a process in which the Medicare program covers new technologies on the basis of scientifically sound clinical evidence, with appropriate health and safety protections in place for the Medicare population.”

See a theme here? 

DMPAG and TCET have similar aims in using innovation and evolving evidenced based approaches to improve the overall care and health for Medicare beneficiaries.

CMS is also hosting listening sessions to engage the industry in TCET. Information on sessions’ focus and aim is below:

CMS is hosting a series of public meetings to obtain feedback to help inform CMS’ development of an alternative coverage pathway to provide transitional coverage for emerging technologies. 

These meetings are part of several steps CMS is taking to help better achieve the goals of timely and predictable Medicare coverage of devices while ensuring that Medicare covers items and services on the basis of scientifically sound clinical evidence and with appropriate safeguards. 

The transcript and recording for the February 17 meeting can be found here.

The framework for the second listening session held on March 31 built upon information gathered in the first session. 

CMS requested feedback on the following questions:

  1. Do stakeholders find CMS guidance on acceptable outcomes and durations of follow-up useful within specific therapeutic areas?
  2. Engagement with CMS should occur after the results of pivotal clinical trials are available, but early enough to expedite coverage after FDA market authorization.  As we streamline the coverage review process, what is the appropriate timing of stakeholder engagement with CMS?
  3. As we work to provide a more collaborative evidence development process, what are stakeholders thoughts on:
  4. Should CMS provide early feedback on strengths and weaknesses of the available evidence based upon a preliminary systematic literature review?
  5. Should manufacturers propose a fit-for-purpose evidence development plan to resolve any evidence gaps identified during the preliminary systematic literature review as part of the national coverage determination process?
  6. How should CMS approach evidence development requirements for similar devices that are FDA market authorized after a Coverage with Evidence Development decision is finalized?

Providers unable to attend should reference forthcoming MLN articles for more detail on this newly emerging area of Transitional Coverage for Emerging Technologies.

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.