Understanding the CPT® Codes for Remote Therapeutic Monitoring (RTM)
A CPT® code (or Current Procedural Terminology code) is a numerical code assigned to each medical procedure and service. These codes are used by healthcare providers to describe the services they provide to patients for billing and insurance purposes.
There are six CPT® codes for Remote Therapeutic Monitoring (RTM), only four of which are relevant to musculoskeletal conditions (the fifth being specific to respiratory system conditions and the sixth relating to cognitive behavioral therapy). For that reason, we’ll provide a detailed overview of the four MSK applicable codes.
Furthermore, the RTM CPT codes are broken down into two basic types: service codes and treatment management codes.
Below are some examples and key differences between the two:
- Providing the necessary ‘medical device’ to the patient
- Providing assistance in setting up the device
- Educating the patient on RTM, data collection strategies, and best practices for success in the RTM model
- Collection and transmission of data
Treatment Management Codes
- Time spent reviewing, monitoring and analyzing the patients data, making adjustments to the program and interacting with the patient or caregiver, during the calendar month
What are the CPT Codes for RTM?
RTM Billing Logistics
CPT Code Billing Frequency
CPT® Code 98975: Initial Set-up and Patient Education
This code may be billed for a patient once per episode of care. By definition, an episode of care begins when the RTM service starts, and ends when established treatment goals are met. You cannot bill code 98975 if less than 16 days of monitoring occurred.
CPT® Code 98977: Supply of Device for Monitoring Musculoskeletal System
This code can be billed for a patient once each 30 days. In other words, if the patient continues to be actively involved in the RTM service, and you continue to provide the ‘medical device’, you may continue to bill this code in subsequent 30 day periods. You cannot bill code 98977 if less than 16 days of monitoring occurred during the 30-day period.
CPT® Code 98980: Monitoring/Treatment Management Services, first 20 minutes
This code can be billed once per calendar month for the first 20 minutes of care provided to the patient. For instance, if you perform a total of 20 minutes during the month speaking directly with the patient regarding their therapy program, monitoring their pain level data, and reviewing their exercise compliance, you qualify to bill this code. However, if you perform only 19 minutes of these services, you do not qualify.
CPT® Code 98981: Monitoring/Treatment Management Services, each additional 20 minutes
This code can be billed if you perform additional services as outlined in code 98980 beyond the initial 20 minutes, during the same calendar month. For instance, if you perform an additional 22 minutes answering the patient’s questions, and reviewing and analyzing data, you qualify to bill this code. However, if you only perform an additional 15 minutes of the services, you do not qualify.
*Please note, you are only eligible to bill codes 98980 and 98981 if at least one ‘interactive communication’ with the patient is performed during the calendar month. According to CMS, ‘interactive communication’ refers to “at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.” In other words, a phone or video call. This interactive communication must occur with the patient/caregiver within the first 20 minutes each month.
Who Qualifies for Billing for RTM?
According to CMS, the CPT® codes for RTM can be billed by “physicians and other eligible qualified healthcare professionals”. RTM services are within the scope of practice of several disciplines, including the following:
- Physical Therapists
- Occupational Therapists
- Speech Language Pathologists
In all cases, providers must practice in accordance with applicable state and scope of practice laws.
Participating Insurance Plans
At the inception of RTM, the codes were recognized solely by traditional Medicare and many Medicare Advantage plans. However, over time, there has been adoption from many commercial payors.
The Bottom Line: To abide by rules and regulations of the codes (of which there are many), it is strongly recommended to work directly with an RTM company who has considered all of the associated Federal legal requirements. To learn more about the codes, recognized payors, and better understand the ROI for your organization, Reserve a Demo with a member of our team.
Disclaimer: The Medicare billing advice provided here is solely for informational purposes and represents our interpretation of the Medicare guidelines. We strongly advise healthcare providers to consult the official Medicare guidelines and regulations, as they are subject to change and may differ from our interpretation. Providers are ultimately responsible for ensuring compliance with Medicare billing guidelines, and any decisions made based on the information provided here are made at their own risk.