In case you missed it. The Centers for Medicare and Medicaid Services (CMS) developed a new remote therapeutic monitoring (RTM) policy for outpatient rehab therapy services in 2022. This means your practice can now bill for patient monitoring and management that happens outside of the clinic setting.

With this new policy comes five new CPT Codes for RTM services. Understanding how to use RTM codes correctly allows you to capture this new stream of revenue to reduce costly reimbursement delays and streamline the billing process.

RTM vs. RPM explained

Outpatient therapists use RTM to collect information about the patient’s response to therapy, adherence to the therapeutic regimen, musculoskeletal or respiratory symptoms experienced, and other nonphysiological information. The patient self-reports this data, which the provider enters into the electronic medical record.

These services are different from those provided with remote physiological monitoring (RPM), which collects and transmits vital signs and related information with electronic technology. While RPM billing requires the use of Bluetooth technology, RTM billing does not. Instead, it must use a web-based platform classified as software as a medical device (SAMD), which surveys patients about symptoms, medication adherence, pain levels, and other aspects of treatment and outcomes.

CPT codes for remote therapeutic monitoring

CMS has designated five codes for RTM that relate to speech-language, occupational, and physical therapy.

Code NameCPT CodeDescriptionBilling Frequency
Initial Set-up and Patient Education98975Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy
adherence, therapy response); initial set-up and patient education on use of equipment
Billed once during
the episode
Supply of Device for Monitoring Respiratory System98976Remote therapeutic monitoring (e.g., respiratory 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
Can be billed every
30 days
Supply of Device
for Monitoring Musculoskeletal
System
98977Remote 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
Can be billed every
30 days
Monitoring/Treatment Management Services, first 20 minutes98980Remote 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; first 20 minutes
Can be billed every
calendar month
Treatment
Management Services, each additional 20 minutes
98981Remote 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)
Can be billed every
calendar month

You can also download a printable RTM code cheat sheet here.

According to CMS, treatment management services must be provided by a therapist or therapy assistant and may include the collection and analysis of self-reported patient data regarding signs and symptoms of the condition and the response to treatment. Each coded session must include a telehealth visit or telephone call; providers may not code direct online messaging sessions with clients.

How to use RTM codes

Let’s look at an example to illustrate correct Medicare billing for RTM therapy. After an initial evaluation for a sports-related injury, a patient sees a physical therapist and receives a care plan for treatment of the affected arm and shoulder. The plan involves accessing exercises and educational resources at home through a dedicated outpatient therapy software PT app or HEP software, which the patient can also use to keep track of the exercises and report back to the therapist about symptoms, range of motion, and other outcomes.

When you initially treat this patient, you use code 98975 to reflect that you educated him about how to use the app and what types of outcomes and actions to record. During the 30-day treatment plan, you keep track of the patient’s use of the app and how well he is sticking to the prescribed exercises. You use code 98980 for the first 20 minutes you spend checking in with the patient and code 98981 for the remaining telehealth visits that take place between clinic visits. After the first month of the treatment plan, you would use code 98977 to bill time spent reviewing patient RTM data.

The future of RTM

Medicare and Medicare Advantage plans accept these RTM billing codes as of January 1, 2022. Commercial payers are also expected to follow a similar protocol for remote therapeutic management claims. Your practice can take advantage of these new codes to cover the cost of buying and using an RTM app as well as provider time spent on patient management outside the clinic.

With CMS finalizing remote therapeutic monitoring codes for outpatient rehab therapists, practices can claim an additional $200 or more per patient in a 60-day care cycle. The CMS rule highlights the value of outpatient therapy services as we increasingly shift from fee-for-service reimbursement to payments based on care quality and patient outcomes. This is an important benchmark for these providers as practices can finally bill for essential services they have been providing all along.

Connect with Clinicient for expert guidance about the new RTM codes. Download our RTM Coding for Outpatient Rehab Therapy cheat sheet for an easy reference when it’s time to file reimbursements for remote therapeutic management.

References:

Keet Health
APTA
CMS
ASHA

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