This is part one of a two-part series. For more answers to key questions about RTM, access part two.
The recently launched 2022 Medicare Fee Schedule includes five new CPT codes for remote therapeutic monitoring (RTM). But what is RTM and how can it benefit your practice? In this article, we answer common questions about RTM, including how it works, who can bill, how to use the new codes, and strategies for incorporating RTM into clinical practice.
What is Remote Therapeutic Monitoring?
Remote Therapeutic Monitoring allows providers to bill for the remote management of their patients with musculoskeletal and respiratory conditions using medical devices (including certain software) that collect non-physiological data. Prescribing home exercise programs to patients is standard practice for rehab therapists, but until now, providers haven’t been incentivized to interact with patients between sessions to monitor and encourage adherence to their home exercise programs.
However, with the new CPT codes launched by CMS, you can now be reimbursed for collecting “therapeutic data” using the virtual patient engagement and monitoring techniques that many of your clinicians are already performing today—opening up new revenue streams of up to $25,000 per provider.
What is the difference between Remote Therapeutic Monitoring and Remote Patient Monitoring?
Remote patient monitoring is the use of digital technology to capture and analyze patients’ physiological data, such as blood pressure, glucose levels, and lung function. By contrast, remote therapeutic monitoring focuses on non-physiological data, such as patient adherence and reported pain levels.
With remote therapeutic monitoring, the patient doesn’t necessarily need to use a device. You simply need a platform that is able to track quantitative and subjective data from patients. There are many ways to collect this information, including software, a web portal, a mobile app, or from a wearable.
Who can bill for Remote Therapeutic Monitoring (RTM)?
According to CMS, physicians and other “eligible qualified healthcare professionals” are permitted to bill for RTM. In the final rule, CMS says it expects the primary billers of RTM codes to be physiatrists, nurse practitioners, and physical therapists. However, other providers can use the codes as well, including occupational therapists, speech-language pathologists, physician assistants, nurse practitioners, and clinical social workers.
What do I need to know about the new CPT codes for Remote Therapeutic Monitoring?
Here’s the information you need to get started incorporating each of the new remote therapeutic CPT codes into your practice, including what each code covers, how to use it, and what to document.
Note that for RTM, an episode of care begins when remote monitoring of a specific condition or treatment goal is initiated and ends when the targeted data is collected and/or treatment goals are met. Also, monitoring devices and systems must be approved by the U.S. Food and Drug Administration (FDA). Check directly with the device manufacturer regarding FDA device status.
CPT Code 98975
CPT code 98975 covers: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), initial set-up, and patient education on use of equipment. Essentially initial patient education. It’s necessary to have patient goals.
How to use CPT code 98975: Report this code only once per episode of care and only if monitoring occurs over a period of at least 16 days. Use this code to report the initial time spent setting up and teaching the patient/caregiver how to use the device.
What to document: The type of device being used, the specific education and training provided to the patient and/or caregiver, and any device set-up required.
CPT Code 98976
What CPT code 98976 covers: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days.
How to use CPT code 98976: Report this code only if monitoring a patient’s respiratory system, and only if the monitoring occurs over a period of at least 16 days.
What to document: The name and description of the device provided for monitoring of the respiratory system.
CPT Code 98977
What CPT code 98977 covers: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days.
How to use CPT code 98977: Report this code only when monitoring the musculoskeletal system, and only if monitoring occurs over a period of at least 16 sequential days.
What to document: Document the name and description of the device provided for monitoring of the musculoskeletal system.
CPT Code 98980
What CPT code 98980 covers: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.
How to use CPT code 98980: Use to report the first 20-minute increment of time spent reviewing and integrating the data collected during remote monitoring to inform treatment goals; monitor the patient’s progress and adherence to the treatment plan; and provide clinical feedback to the patient/caregiver.
Count cumulative time spent in data review and patient/caregiver interaction in a calendar month (not each 30 days). Report the base and add-on codes together on the claim, based on total time, at the end of each calendar month. The base code (98980) may only be reported once per calendar month. Don’t report CPT code 98980 unless a full 20 minutes of monitoring has occurred.
What to document: Document the data gathered from the device, the date and time of the patient and/or caregiver interaction, and any decisions made that impact the treatment and plan of care as a result of the monitoring.
CPT Code 98981
What CPT code 98981 covers: Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month, each additional 20 minutes. (List separately in addition to code for primary procedure.)
How to use CPT code 98981: Use to report each subsequent 20-minute increment of time spent reviewing and integrating the data collected during remote monitoring to inform treatment goals; monitor the patient’s progress and adherence to the treatment plan; and provide clinical feedback to the patient/caregiver. Don’t report CPT code 98981 unless a full additional 20 minutes of monitoring has occurred. CPT code 98980 must be billed if CPT code 98981 is being billed.
What are the benefits of Remote Therapeutic Monitoring?
In addition to significant financial gains, remote therapeutic monitoring can also provide valuable benefits such as:
- Key insights into patient adherence and satisfaction.
- Significantly improved patient activation, engagement, and rapport.
- Early intervention based on how the patient is doing with their care program.
- Advanced data for providers to act on leading to improved decision-making for care.
- Improved patient functional outcomes and pain levels.
- Reduced costs as patients begin to improve faster.
- A better provider-patient connection over a longer period.
- Improved patient self-efficacy as patients learn how to better manage their condition.
How can MedBridge help with Remote Therapeutic Monitoring?
MedBridge’s Patient Engagement Solution allows providers to digitally assign programs to patients with musculoskeletal, respiratory and other conditions. Providers can then monitor non-physiologic patient data including program adherence, pain levels, and patient feedback; communicate with patients between sessions using in-app messaging and virtual visits, and adjust the program as needed to optimize patient outcomes.
Our effective, evidence-based solution satisfies the FDA requirements for a medical device and is eligible to be used for patient monitoring. It integrates MedBridge’s Home Exercise Program, Patient Education, Patient Mobile App, Adherence Tracking and Reporting, Telehealth Virtual Visits, and Net Promoter Score for monitoring and improving patient satisfaction.
This is part one of a two-part series.