Remote therapeutic monitoring (RTM) refers to the use of technology to track and remotely monitor a patient's health status, treatment progress, and adherence to a provider’s plan of care, specifically for musculoskeletal and respiratory patients. The Centers for Medicare and Medicaid Services (CMS) approved the RTM CPT® codes for coverage and payment in the 2022 Physician Fee Schedule.
According to the rules published by the CMS, RTM refers to the collection and monitoring of "non-physiological data" via an approved "medical device".
Non-physiological data includes musculoskeletal system status, therapy adherence, and therapy response (think pain scores, exercise compliance data, and outcome measures).
The medical device must meet the definition of a medical device, as defined by the United States Food and Drug Administration (FDA): An instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease
The creation and approval of the RTM CPT codes by CMS is a significant value add for providers, patients, and payors. There are many benefits of implementing the service into normal practice. Below are just a few key examples:
- Improve data-driven clinical decision making
- Improve patient access to care
- Improve patient engagement and outcomes
- Improve patient-provider communications & relationships
- Increase net patient revenue
- Reduce downstream total cost of care
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:
- Physical Therapists
- Occupational Therapists
- Speech Language Pathologists
The RTM codes, classified as general medicine codes, open up opportunities for allied health professionals, psychologists, and other eligible practitioners who cannot currently bill for Remote Physiological Monitoring (RPM). In all cases, providers must practice in accordance with applicable state and scope of practice laws.
RPM services are only for physicians and certain non-physician practitioners (e.g. physician assistants, nurse practitioners) and are intended to monitor a patient’s physiologic parameters such as weight, blood pressure, pulse oximetry or respiratory flow rate. RPM is typically used to monitor chronic conditions such as hypertension, diabetes, and heart disease.
RTM was created to focus on musculoskeletal and respiratory systems, therapy adherence and therapy response, and represents the review and monitoring of data related to signs, symptoms and functions of a therapeutic response. Importantly, RTM expands the types of providers allowed to bill these codes to include physical therapists, occupational therapists, and speech language pathologists.
Read our Blog on the Difference Between RTM and RPM
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. With our experience, we have identified several additional payors covering RTM codes. To learn more and better understand the ROI for your organization, click here to speak to a member of our team.
There are six CPT codes for RTM, four of which are relevant to musculoskeletal conditions (the fifth being specific to respiratory system conditions and the sixth relating to cognitive behavioral therapy). The four codes applicable to MSK conditions include:
- CPT® Code 98975: Initial Set-up and Patient Education
- CPT® Code 98977: Supply of Device for Monitoring Musculoskeletal System
- CPT® Code 98980: Monitoring/Treatment Management Services, first 20 minutes
- CPT® Code 98981: Monitoring/Treatment Management Services, each additional 20 minutes
CPT® Code 98975: Initial Set-up and Patient Education
This code may be billed for a patient once per episode of care, if a minimum of 16 days of monitoring has occurred.
CPT® Code 98977: Supply of Device for Monitoring Musculoskeletal System
This code can be billed for a patient once each 30 days, if a minimum of 16 days of monitoring has 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.
CPT® Code 98981: Monitoring/Treatment Management Services, each additional 20 minutes
This code can be billed if an additional 20 minutes of services as outlined in code 98980 is performed, beyond the initial 20 minutes, during the same calendar month.
*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. This interactive communication must occur with the patient/caregiver within the first 20 minutes each month.