The new CPT codes for RTM

Written by Dr. Lisa Palmerino PT, DPT

Nwe CPT Codes for RTM: A Snapshot of What You Need to Know

Remote therapeutic monitoring (RTM) is a growing topic of conversation in therapeutic healthcare fields. While some are dipping their toes into the water with RTM, others have already dove in head first fully implementing technological advances to facilitate better outcomes for patients, clinicians and facilities. That being said, healthcare workers are wanting clarification surrounding a key topic: billing. Are you still wondering what parameters need to be met in order to seek reimbursement for RTM  services? If so, keep reading to learn more about:

  • The specific RTM CPT codes
  • What they CPT codes mean
  • When they can be billed
  • Who can bill for them
  • Important considerations

 

The RTM CPT codes ¹ ²

5 RTM CPT codes went into effect with established reimbursement by Centers for Medicare and Medicaid Services (CMS) at the beginning of this year on January 1st, 2022. Since this time some commercial insurance carriers are beginning to follow suit. Below is an outline including the code itself, description and average national reimbursement rate.

5 RTM CPT codes

 

What the codes mean?¹ ² ³

98975: Think of this as a set-up code. It may only be billed one time for an individual patient’s plan of care, and since codes are billed on a monthly basis, this code will only be billed for the first month a RTM service is used. CMS recognizes the importance of education and is respecting the time required for setup of a RTM solution with a given patient. 

98976: This code reflects use of the service providing remote data transmission relative to the respiratory system. This code can be billed once every 30 days only if a compliance threshold of successful data transmission for 16 days is met.

98977: This code refers to data transmission which informs on a patient’s musculoskeletal (MSK) status. This code can be billed once every 30 days only if a compliance threshold of successful data transmission for 16 days is met.

98980: This is a time-based code that reflects the first 20 minutes of care management accumulated in the calendar month. Another way to think of care management and billable time if for A) time spent reviewing data and what data was reviewed or B) time spent conversing with a patient and/or caregiver regarding the data/ insights and plan moving forward. Unlike code 98981, this code may only be billed once a month. This code can be billed only if the 16 days compliance requirement is met.

98981: Similar to 98980, this is a timed-based code reflective of each subsequent 20 minutes of care management accumulated in the same calendar month. The same indications for billable time apply as with 98980. Theoretically, this code can be billed more than once in a given month. This code can be billed only if the 16 days compliance requirement is met.

 

When are the codes billed? ¹ ² ³

These CPT codes (98975, 98976, 98977, 98980, 98981) are billed,  when applicable, on a monthly basis. 98976 and 98977 are based on a 30 day period, while 98980 and 98981 are per calendar month.

 

Who can bill? ¹ ³

The recognized and demonstrated value of RPM services (which were established a few years ago) has facilitated the development of RTM services with the intention of extending the benefits of remote monitoring services as a complimentary service to the skilled therapy professions. Qualified health professionals (QHPs) may provide the services and bill for them. Note:

  • Qualified health professionals including physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), physical therapy assistants (PTAs) and certified occupational therapy assistants (COTAs) can bill for and provide management of RTM services.
  • It is important to note that the initial setup (98975) must be done by a PT, OT, or SLP and the “di minimis standard” applies when greater than 10% of the subsequent care management is performed by a PTA or COTA. Therefore, the CQ and CO modifiers in conjunction with the GP and GO modifiers, respectfully, for PTA and COTA services provided are applicable in outpatient settings.

Important considerations 1 2 4

  • What is the patient’s engagement with the technology?
    • Clinical impact and revenue streams cannot be optimized without patient compliance. Therefore, this is such an important consideration when choosing a RTM solution. Owlytics has a very high compliance rate in the older adult patient population (greater than 18 hours per day) which permits greater amount of data to inform the continuously monitored health metrics to establish trends and makes the 16 day compliance threshold requirement (for CPT code 98976 or 98977) easy to meet.
  • What is the clinical impact?
    • Ask yourself
      • Is the service easily integrated into a clinician’s workflow? 
      • Is clinical decision making more efficient and well-informed?
      • Are tracking patient goals supported by data and the insights provided by the technology?
      • Does patient engagement and overall satisfaction improve?
      • Can the data be shared to promote greater interprofessional collaboration?
    • For example, Owlytics RTM solution provides insights to many health metrics with continuous monitoring to establish functional baselines, trends, objective insights and self-reported symptoms for a more holistic approach to care with an emphasis on preventative health. High compliance and patient satisfaction in addition to improved staff efficiency and inter-professional communications have all been reported.
  • Is the RTM solution you implement “future proof”?

Ensuring RTM vendors and technologies meet the highest industry standards may help avoid disruptions to providing these services or disruptions in revenues with any changes to requirements and fee schedules moving forward. For example, many technologies meet the FDA’s broad definitions to qualify as a medical device. However, not all technologies are FDA listed. You can check the status of FDA listed companies here.

 

Summary

In a time when various interventions provided by skilled therapists are receiving less support via reimbursement cuts, it is important to recognize the opportunity with the establishment of new CPT codes and available reimbursement for services to provide our patients. Enhanced patient outcomes, improved provider experiences and financial support via innovative technologies is something we should embrace. It is directly within our control to make a difference and push the landscape of rehabilitative services forward.

 

References

  1. Centers for Medicare and Medicaid Services Dof Hand HS, ed. Transmittal 11118. Change Request 12446. Pub 100-04 Medicare Claims Processing – CMS Manual System. https://www.aapc.com/codes/exclusives/transmittals/2022-annual-update-to-the-therapy-code-list-6681. Published November 10, 2021. Accessed May 3, 2022.
  2. Tomeronen. Owlytics Healthcare. https://www.owlytics.com/. Published March 14, 2022. Accessed June 26, 2022. 
  3. Billing examples using CQ/CO modifiers for services furnished in whole or in part by PTAS and Otas. CMS. https://www.cms.gov/medicare/therapy-services/billing-examples-using-cqco-modifiers-services-furnished-whole-or-part-ptas-and-otas. Published November 11, 2021. Accessed July 1, 2022. 
  4. Center for Devices and Radiological Health FDA. How to determine if your product is a medical device. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/classify-your-medical-device/how-determine-if-your-product-medical-device. Published December 16, 2019. Accessed June 4, 2022. 
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