In 2022, Medicare added 5 new CPT codes (98975, 98976, 98977, 98980, 98981) for remote therapeutic monitoring (RMT). Although insurance changes are often never a good thing – in this case if done right, this change could actually help your clinic. In this article, we’ll address what are the new CPT codes for RMT and how to use the codes in your practice to improve patient results and reimbursement.
What is RTM or Remote Therapeutic Monitoring?
Remote Therapeutic Monitoring, according to MedBridge, “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.”
This is great news as many of us wish we could be rewarded for checking in on our patients – many times this is unbilled time that, as clinicians, we do out of the kindness of our hearts. This could help emphasize better care by monitoring how patients are doing with their home exercise programs and addressing questions or issues before 1-2 weeks or even longer passes.
With the new CPT codes launched in 2022, you can now be reimbursed for collecting “therapeutic data” using monitoring and virtual check in’s – according to MedBridge this could open up new streams of up to $25,000 per provider”! https://www.medbridgeeducation.com/blog/2022/03/remote-therapeutic-monitoring-your-questions-answered/
Who can bill for RTM?
According to CMS, physicians and other qualified healthcare professionals can bill for RTM. The list of qualified professionals includes physiatrists, nurse practitioners, physical therapists, occupational therapists, speech-language pathologists, physician assistants, and clinical social workers to name the main providers who will be using these codes.
How to bill for Remote Therapeutic Monitoring?
First, RTM codes can seem very similar to RPM codes. So we first want to clarify that RPM codes are evaluation/management codes billed by physicians or qualified healthcare providers” while RTM codes are “general medicine codes and the major utilizers of RTM codes are expected to be physical therapists, clinical psychologists, speech-language pathologists, and occupational therapists.” According to Healthsnap. https://healthsnap.io/rpm-vs-rtm-whats-the-difference/
RPM usually uses more physiological data collection, such as blood pressure, blood sugar, and lung function – think what do doctors and nurses often collect in their offices. In contrast, RTM focuses on data that would be more often collected in therapy clinics – such as pain levels, patient compliance, and other more non-physiological data and it’s more subjective than objective. Another example would be that RPM would use heart rate or blood pressure monitors while RTM would use a wearable device like a Fitbit and perhaps tracking of how often one viewed their home exercise programs (which can often be tracked in any course or HEP portal). It is important to note that any monitoring devices must be approved by the FDA.
Now that we’ve cleared up the difference between RPM and RTM, let’s teach you how to use these in your practice to add additional revenue and improved patient results.
CPT 98975: “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*quoted from 2022 Physician Fee Schedule (see resources for PDF)
CPT code 98975 covers the initial set up and education involved when you first being remote therapeutic monitoring. For example, you want to introduce your patient to the Apple watch or Fitbit (both are FDA approved for the heart rate monitoring and the apple watch also for it’s EKG) so that you can monitor the intensity of their exercise as they perform your home exercise program. The time spent educating them on tracking their data, the importance of that data, how to understand the data and initial set up would all be billable now under CPT code 98975. It can also be as easy as providing your patient with a HEP program on an online platform and one which you can monitor their progress.
This code is used only once as it’s like an initial evaluation and can only be used if you plan to monitor over at least 16 days.
You need to document the type of device used, what education and training you performed, and any time spent setting up the device for monitoring.
CPT Code 98976: “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” Quoted from 2022 Fee Schedule.
CPT code 98976 covers only if you are monitoring a patient’s respiratory system and if that monitoring is over 16 days.
You must document the name of the device provided to monitor one’s respiratory system and a description of the device as well as therapy adherence and response or any alerts triggered.
CPT Code 98977: “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)”. Quoted from 2022 Fee Schedule.
CPT code 98977 covers only if you are monitoring the musculoskeletal system and if monitoring occurs over 16 days.
Similarly to the above code, you’ll document that device name, description, any alerts that were triggered, how the patient is responding, and therapy adherence.
CPT Code 98980: Remote therapeutic monitoring treatment, 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”. Quoted from 2022 Fee Schedule.
CPT code 98980 covers the first 20 minute increment of time spent reviewing the data collected and compiling the data during the remote monitoring period that will be used to educate your patient on their progress and the time spent providing your clinical feedback to the patient and/or caregiver.
This code requires at least 1 interactive communication during the calendar month, and it’s the first 20 minutes that you’ll be billing for. This code is only to be used once per calendar month and only if a full 30 minutes of monitoring has occurred.
Calculating the time spent on monitoring and integrating the data can be tricky and so CMS reports you want to count the time spent in data review and patient or caregiver interaction in one calendar month and NOT each 30 days.
Make sure to document the data gathered, the date and time of the patient/caregiver interactions and duration, and key results from this that may have affected the plan of care or treatment.
“You’ll report this base code (98980) and then any add on codes together on one claim based on the toal time, at the end of the month “ according to Medbridge.
CPT Code 98981: “Remote therapeutic monitoring treatment, 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; each additional 20 minutes.” Quoted from 2022 Fee Schedule.
CPT code 98981 covers each 20 minute increment of time spent reviewing, integrating, monitoring, and educating the patient/caregiver on the information from the remote monitoring. A full 20 minutes needs to have been performed in order to bill for this and have first billed CPT 98980 as that covers the 1st 20 minutes.
CPT code 98981 and 98980 are allowed to be billed whether you perform a phone call or tele health visit, as long as there is an “audio component” according to MedBridge.
Why use Remote Therapeutic Monitoring codes in your practice?
Engaging more with your patient’s outside of the clinic shows that you care and are interested in their progress. You’ll stand out compared to other clinics and help with patient retention and also potentially patient referrals.
You’ll also hopefully see better patient outcomes, as you’ll be able to catch adverse effects, challenges or barriers to a home exercise program, and variety of other factors that may affect your clinic’s patient’s outcomes.
Lastly, you’ll see improved financial gains – not just directly through reimbursement from RMT codes but also hopefully indirectly with patients returning for more appointments or providing you referrals.
Break down of potential profits using RTM codes in your private practice:
Initiate a remote monitoring system for a patient: bill code RTM 98975 on day 17 and receive roughly $20 per each patient that you’ve initiated this program and monitored for at least 16 days.
After 30 days working with that patient, submit a progress note documenting the patient’s data, your activities monitoring the patient, and their progress. Bill for CPT codes 98977 and 98980 as long as you’ve tracked 16 days for remote progress and interacted at least 20 minutes with the patient or caregiver. You’ll potentially receive $50 for code 98980 for the first 20 minutes and $55 for 98977.
For the first 30 days, you’ll potentially be able to be reimbursed $125 for the 1st 30 days according to PT Progress. You can continue to bill CPT codes 98977 and 98980 for the next 30 days and that’s another $105! If you treated 10 Medicare patients a month, that’s an additional $1200 per month you would receive through Medicare.
At HelloNote, we have integrated billing modules to help you with all of this complicated billing! You can set up your free demonstration here and see how we can help grow your practice with our all in one EMR software: https://hellonote.com/.