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Implementing billing for Remote Therapeutic Monitoring (RTM) at your clinic is a smart move. It enables more personalized care, improves patient outcomes, while increasing your clinic's revenue. However, it’s important to know which Current Procedural Terminology (CPT) codes to bill for and when. In this article, we’ll walk you through the four most commonly used codes and the appropriate times to bill for them.
To learn more about these codes, recognized payors, and how RTM can enhance your clinic’s ROI, book a demo with our RTM expert here.
Background
In 2022, the Centers for Medicare and Medicaid Services (CMS) introduced RTM reimbursement codes. These codes are intended for cases where physicians and non-physician healthcare professionals remotely monitor treatment of musculoskeletal (MSK) conditions using medical devices like Vitala.
RTM Vs. RPM
You might be familiar with Remote Patient Monitoring (RPM), but it’s useful to understand how it differs from RTM. Both play key roles in remote healthcare, yet they cater to different needs.
RPM is designed to collect physiological data such as vital signs and biometric measurements, including blood pressure, heart rate, and glucose levels, using digital sensors.
In contrast, RTM focuses on non-physiological data related to therapeutic interventions. It helps monitor and manage aspects such as treatment effectiveness and medication adherence. Examples of RTM data include:
- Frequency of inhaler use in patients with COPD
- Pain levels in individuals with musculoskeletal conditions
- Adherence to prescribed medication
- Responses to specific therapies or medications
RPM codes are primarily utilized by physicians, while RTM codes are applicable to a wider range of healthcare professionals, known as Qualified Healthcare Professionals (QHPs). This includes clinical psychologists, physical therapists, occupational therapists, nurse practitioners, and behavioral health specialists.
RTM Billing
What are the CPT Codes for RTM?
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Code 98975: Initial Set-up and Patient Education
CPT code 98975 covers the initial set-up of the device, such as when a patient downloads and logs into the Vitala app, as well as educating them on its use. This code can be billed once per episode of care. Note that you cannot bill for code 98975 unless you have at least 16 days of monitoring data.
Code 98977: Supply of Device for Monitoring MSK System
CPT code 98977 is used when a patient remains actively engaged with the RTM device, like the Vitala app, and you continue to provide the medical device. This code is billed once every 30 days, provided that at least 16 days of monitoring occurred during the 30-day period.
Code 98980: Monitoring/Treatment Management Services, first 20 minutes
CPT code 98980 covers the first 20 minutes of monitoring a patient’s RTM data within a calendar month. This includes reviewing exercise compliance, therapeutic responses, or pain levels. You can bill for this code if you perform at least 20 minutes of monitoring in the Vitala Care Portal with at least one interactive communication with the patient. Billing is only allowed if you meet the 20-minute threshold. You can bill for code 98980 once per calendar month.
Code 98981: Monitoring/Treatment Management Services, each additional 20 minutes
If you have billed for code 98980, use code 98981 to bill for each additional 20 minutes of monitoring within the same calendar month. For example, if you conduct an additional 22 minutes of monitoring with at least one interactive communication, you can bill for this code.
Note: 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 transmissions.” In other words, a phone or video call. You are only eligible to bill for codes 98980 and 98981 if at least one interactive communication is performed during the calendar month.
Who Qualifies for Billing for RTM?
According to CMS, the CPT codes for RTM can be billed by “physicians and other qualified healthcare professionals” (QHPs).
QHPs include:
- Physicians
- Nurse practitioners
- Physical Therapists
- Occupational Therapists
- Speech Language Pathologists
- Clinical psychologists
- Behavioral health specialists
These professionals are eligible to bill for RTM services as long as they meet the criteria set by CMS
Participating Insurance Plans
Initially, RTM codes were recognized exclusively by traditional Medicare, Medicaid, and many Medicare Advantage plans. However, there has been growing adoption among commercial payors over time. Contact us to learn more!
Getting Started with RTM Codes through Vitala
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Integrating Vitala into your clinic’s workflow not only enhances patient outcomes through proactive, dose-specific exercise prescriptions but also opens up new revenue opportunities—potentially adding over $150 per patient, per month.
Here’s how to get started in 4 simple steps:
- Schedule an Introductory call
Contact us to arrange a call where we’ll provide a detailed overview of the Vitala service.
- Onboard Your Patients
In the Vitala Care Portal, onboard your patients by setting personalized SMART goals and entering their unique health parameters, such as medical diagnoses and functional abilities. Prescribe exercises based on our recommendations, or customize them as needed.
- Monitor and Support
Use the Vitala Care Portal to monitor and support your patients. The portal tracks your monitoring time and interactive communications, helping you determine when you qualify for RTM reimbursement.
- Bill for RTM Reimbursement
Once you’ve met the CPT code criteria, submit your claim for RTM reimbursement.
So, achieving better patient care while increasing your clinic’s revenue is now a reality with Vitala.
Get started today!
