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The 2022 Medicare Fee Schedule includes five new CPT codes for remote therapeutic monitoring (RTM). Remote Therapeutic Monitoring 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. Prescribing home exercise programs to patients is standard practice for rehab therapists, but until now, providers haven’t been incentivized to interact with patients between sessions to monitor and encourage adherence to their home exercise programs.
However, with the new CPT codes launched by CMS, you can now be reimbursed for collecting “therapeutic data” using the virtual patient engagement and monitoring techniques that many of your clinicians are already performing today—opening up new revenue streams of up to $25,000 per provider.
Learn more about each of the 5 new codes below.
- Device Education and Onboarding (CPT Code 98975)
- Device Supply (CPT Code 98976 and 98977)
- Remote Treatment (CPT Code 98980 and 98981)
- Facility vs. Non-facility Designation
Device Education and Onboarding (CPT Code 98975)
CPT code 98975 covers: 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.
How to use CPT code 98975: Report this code only once per episode of care and only if monitoring occurs over a period of at least 16 days after patient activation. Use this code to report the initial time spent setting up and teaching the patient/caregiver how to use the device.
What to document: The type of device being used, the specific education and training provided to the patient and/or caregiver, and any device set-up required.
Device Supply (CPT Code 98976 and 98977)
What CPT code 98976 covers: 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.
What CPT Code 98977 covers: 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.
How to use these codes: Report 98976 only if monitoring a patient’s respiratory system and report 98977 only if monitoring a patient’s musculoskeletal system. With both codes, only report if the 16 days of data collection has occurred in a 30-day period.
What to document: The name and description of the device provided for monitoring of the respiratory or musculoskeletal system along with the dates covered.
It’s recommended to bill for this milestone once per month, but remember that this code looks at any 30 day period, so that doesn’t necessarily need to occur at the end of the month. You can use MedBridge to pull a report of the patient’s activity.
Remote Treatment (CPT Code 98980 and 98981)
What CPT code 98980 covers: Remote therapeutic monitoring treatment management services, 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.
What CPT code 98981 covers: Remote 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.
How to use CPT code 98980 & 98981: 98980 is used to report the first 20-minute increment of time spent reviewing and integrating the data collected during remote monitoring to inform treatment goals; monitor the patient’s progress and adherence to the treatment plan; and provide clinical feedback to the patient/caregiver. 98981 is used to report each subsequent 20-minute increment.
Count cumulative time spent in data review and patient/caregiver interaction in a calendar month (not each 30 days). Report the base and add-on codes together on the claim, based on total time, at the end of each calendar month. The base code (98980) may only be reported once per calendar month.
Don’t report CPT code 98980 unless a full 20 minutes of monitoring has occurred, don’t report CPT code 98981 unless a full additional 20 minutes of monitoring has occurred. Note that CPT code 98980 must be billed if CPT code 98981 is being billed.
What to document: Document the data gathered from the device, the date and time of the patient and/or caregiver interaction, and any decisions made that impact the treatment and plan of care as a result of the monitoring.
Facility vs. Non-facility Designation
Depending on how your clinic or department is designated, either as a facility or a non-facility, your billing process will vary. The codes you can bill along with how much you can be reimbursed vary based on which billing system you use:
- For facility-based providers billing the Outpatient Prospective Payment System, bill codes 98975, 98976, and 98977. Codes 98980 and 98981 are unavailable.
- For non-facility providers billing the Medicare Physician Fee Schedule, all 5 codes codes described in this article can be billed.
*For specific billing questions we recommend checking with your MAC and your own internal billing department to verify all information