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Medtronic — Technical Presentation (April 2023)
44 slides from Medtronic's technical presentation, April 2023
Slide 1: 2023 coding and reimbursement update for diabetes technology
2023 coding and reimbursement update for diabetes technology US-DBA-2300016 © 2023 Medtronic. All rights reserved. Medtronic, Medtronic logo and Engineering the extraordinary are trademarks of Medtronic. Third party brands are trademarks of their respective owners. All other brands are trademarks of
Slide 2: Health equity for people of color living with diabetes
Health equity for people of color living with diabetes >55% of Americans with diabetes are either Black, Native American, Hispanic or Asian. People of Color with type 1 diabetes are less likely to use diabetes-related technology as compared to White Americans. Compared to White Americans 3x Black Am
Slide 3: Medtronic Off-Label Policy
Medtronic Off-Label Policy The content of today’s medical education and training program is limited to the on-label uses of our products You may find our current product labeling online at: http://professional.medtronicdiabetes.com/important-safety-information Questions concerning off-label use of o
Slide 4: Important safety information
Important safety information Minimed™ 770G system with SmartGuard™ technology The MiniMed™ 770G system is intended for continuous delivery of basal insulin (at user selectable rates) and administration of insulin boluses (in user selectable amounts) for the management of type 1 diabetes mellitus in
Slide 5: Important safety information
Important safety information For CareLink™ software Indications for Use The CareLink™ software is intended for use as a tool to help manage diabetes. The purpose of the software is to take information transmitted from insulin pumps, glucose meters and continuous glucose monitoring systems, and turn
Slide 6: Important safety information
Important safety information For InPen™ smart insulin pen The InPen requires a prescription. It is a home-use reusable pen injector for single-patient use by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for the self-injection of a desired dose of
Slide 7: Important safety information
Important safety information CGM/Guardian™ Connect system The Guardian™ Connect system requires a prescription and is indicated for continuous or periodic monitoring of glucose levels in the interstitial fluid under the skin, in patients (14 to 75 years of age) with diabetes mellitus. The system is
Slide 8: Important safety information
Important safety information MiniMed™ 630G system with SmartGuard™ technology Indicated for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus. MiniMed™ 630G system is approved for ages 14 years or older with Guardian™ Sensor 3 and MiniMed™ 630G sy
Slide 9: MiniMed 600 series pump system field corrective action
MiniMed™ 600 series pump system Field corrective action At Medtronic, patient safety is core to our mission. During internal testing, we discovered a potential issue that can result in unauthorized pump access. Subsequently, a communication was sent in September 2022 to patients and the healthcare p
Slide 10: Remote bolus feature
Remote bolus feature Patient training resources MiniMed™ 630G system user guide, MiniMed™ 670G system user guide, Medtronic Diabetes Support website Page 116 Page 138
Slide 11: Disclaimer
Disclaimer Medtronic provides this information for your convenience only. It does not constitute legal advice or a recommendation regarding clinical practice. Information provided is gathered from third-party sources and is subject to change without notice due to frequently changing laws, rules and
Slide 12: Moderator and panelists
Moderator Panelists Katie James Thrasher Linda Holtzman Shepard MD, FACE Arkansas Diabetes and MHA, RHIA, CCS, CCS-P, CPC, COC Reimbursement Consultant, Endocrinology Center Clarity Coding Medtronic Diabetes Little Rock, AR *Compensated for their time. Thoughts and opinions are their own.
Slide 13: Topics for discussion
Topics for discussion 1. Review diabetes technology office workflow and associated coding and payment for services of healthcare professionals related to the diabetes technology 2. Medicare 2023 Reimbursement Updates 3. Discussion of coding scenarios related to diabetes technology 4. Q&A *Please not
Slide 14: Diabetes technology options
Diabetes technology options Insulin pump systems, CGM and smart insulin pens The MiniMed™ 630G system The MiniMed™ 770G system The Guardian™ Connect system The InPen™ system
Slide 15: CPT codes for HCP services and current Medicare rates
CPT codes for HCP services and current Medicare rates There are multiple reportable HCP services associated with use of diabetes technologies Patient Data Patient TREATMENT evaluation analysis: BG, Treatment education MANAGEMENT and selection SG & insulin management and training delivery
Slide 16: Patient evaluation and selection
Office activities when prescribing therapy Evaluate patient – who is a candidate? Patient evaluation Review therapy options and with patient selection Order product – Rx form and submit appropriate paperwork
Slide 17: Office visits
Office visits Coding and Medicare national payment Face-to-Face/Telehealth: Who can bill for Total 2023 Medicare Codes Description this service RVUs1 National Rate1 99202 Office or other outpatient visit for the evaluation and 2.15 $73 Physician, 99203 management of a new patient, which requires a 3
Slide 18: Patient Education and Training
Office activities related to training and education Calculating settings Patient Education Educate and train on device and Training Set data sharing expectations
Slide 19: Calculating settings for therapy
Calculating settings for therapy
Slide 20: Training scenarios
Training scenarios Billable scenarios Non-billable scenarios Insulin pumps and CGMs Trained by Certified Compensated office educator trainer/center Certified Medtronic who is not not Self Start Trainer/Center Trained contracted with compensated by trained Medtronic Medtronic Smart Insulin Pens Train
Slide 21: Education and training – self management on diabetes technology (non-Medicare)
Education and training – self management on diabetes technology Coding and Medicare national payment when performed by certified trainer not contracted with Medtronic Who can bill Total 2023 Medicare Codes Description this service RVUs1 National Rate1 Diabetes outpatient self-management training ser
Slide 22: Education and training – self management on diabetes technology
Education and training – self management on diabetes technology Coding and Medicare national payment when performed by prescribers Who can bill Total 2023 Medicare Codes Description this service RVUs1 National Rate1 99202 Office or other outpatient visit for the evaluation and 2.15 $73 99203 managem
Slide 23: Education and training – self management on diabetes technology
Education and training – self management on diabetes technology Who can bill for Total 2023 Medicare Codes Description this service RVUs1 National Rate1 Continuous Glucose Monitoring Ambulatory continuous glucose monitoring of Physician, NP, PA interstitial tissue fluid via a subcutaneous sensor for
Slide 24: Education and training – medical nutrition therapy
Education and training – medical nutrition therapy Coding and Medicare national payment Who can bill this Total 2023 Medicare Codes Description service* RVUs1 National Rate1 Medical nutrition therapy; initial assessment and intervention, 97802 1.09 $37 individual, face-to-face with the patient, each
Slide 25: Data analysis – SG, BG & insulin delivery
Office activities related to data analysis Receive reports Data analysis – SG, BG & insulin delivery Review reports and analyze data
Slide 26: Data analysis – in person
Data analysis – in person Coding and payment – office visit Blood Glucose & Insulin Delivery Data Analysis Blood glucose data Insulin delivery data When blood glucose data is analyzed in When insulin delivery data is analyzed in person during an office visit, it is part of person during an office vi
Slide 27: Data analysis – remote
Data analysis – remote Coding and Medicare national payment Blood Glucose & Insulin Delivery Data Analysis Who can bill for Total 2023 Medicare Codes Description this service RVUs1 National Rate1 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitall
Slide 28: Data analysis – CGM in person or remote
Data analysis – CGM in person or remote Coding and Medicare national payment Continuous Glucose Monitoring Data Analysis Who can bill for Total 2023 Medicare Codes Description this service RVUs1 National Rate1 Ambulatory continuous glucose monitoring of Physician interstitial tissue fluid via a subc
Slide 29: Interpretation: Remote analysis of insulin delivery and glucose data
Interpretation: Remote analysis of insulin delivery and glucose data Reports from certain devices, e.g., smart insulin pens and insulin pumps, integrate insulin delivery data with glucose monitoring data (either CGM or blood glucose), enabling the data to be interpreted in context and provide a comp
Slide 30: Treatment Management
Office activities related to data analysis Respond and Treatment collaborate with patient Management Treatment Management
Slide 31: Treatment management services – in person
Treatment management services – in person Coding and Medicare national payment Face-to-Face or Telehealth: Who can bill for Total 2023 Medicare Codes Description this service RVUs1 National Rate1 99212 Office or other outpatient visit for the evaluation and 1.68 $57 99213 management of an establishe
Slide 32: Treatment management services - remote
Treatment management services - remote Coding and Medicare national payment Who can bill Total 2023 Medicare Codes Description for this service RVUs1 National Rate1 Remote physiologic monitoring treatment management services, clinical staff/physician/other QHCP time in a Physician, NP, $49 99457 1.4
Slide 33: Considerations for data analysis and documentation
Considerations for data analysis and How are documentation activities captured? How can report data be captured to meet documentation What is the requirements? cadence of follow up?
Slide 34: Documentation/sample remote monitoring chart note discussion
Documentation/sample remote monitoring chart note discussion Template placed into each patient’s chart before billing at the end of the month • Rationale for monitoring • Type of diabetes • Program start date • Current meds • Lab results • Device Name • Method(s) for communicating with patient and/o
Slide 35: 2023 Medicare Updates Related to Diabetes Therapies
2023 Medicare Updates Related to Diabetes Therapies 43
Slide 36: Potentially underutilized services—diabetes self-management training
Potentially underutilized services—diabetes self-management training What existing services are high value but Diabetes self- Screening for underutilized? management diabetes training What obstacles exist?
Slide 37: CMS Coverage Expansion into T2D for CGM
CMS Coverage Expansion into T2D for CGM Effective date of April 16, 2023
Slide 38: 2023 Prolonged services revisions
2023 Prolonged services revisions Prolonged service, with direct Prolonged service on a date other Prolonged service on the date of patient contact than the face-to face E/M service, E/M visit, with or without direct without direct patient contact patient contact Codes Description Codes Description
Slide 39: Telehealth beyond the Public Health Emergency (PHE)
Telehealth beyond the Public Health Emergency (PHE)* • Modifier 95 will continue to be used for telehealth services through the end of 2023. • Telehealth services provided in the physician office setting will continue to be paid at the non-facility rate through the end of 2023. • At the start of 202
Slide 40: Billing Scenario Discussion
Billing Scenario Discussion 48
Slide 41: Management E/M Visit
Available coding scenarios based on current billing instructions Actual code use may differ depending on the clinical needs of each patient as identified by the HCP Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Analysis Education G0108 CGM 95251 95251 95251 95251 95251 95251 95251 95251 95251 9525
Slide 42: Access Helpful Resources & Submit Additional Questions
Access Helpful Resources & Submit Additional Questions Access most current reimbursement resources here: Reimbursement Website Contact the Medtronic Diabetes Reimbursement Team with Additional Questions: RS.diabetesHCPreimbursement@medtronic.com https://www.medtronic.com/us-en/healthcare-professiona
Slide 43: Medtronic Diabetes Digital University
Medical Medtronic Diabetes Digital University Education 100% On- Multiple Customized Demand Medtronic Learning by Content Therapies Job
Slide 44: Thank you!
Thank you! Medtronic