Centers of Medicare and Medicaid Services (CMS) announced the updated and released Medicare Physicians Fee Structure Proposal on July 13th for the following and the coming years. In this schedule, they recognized the importance of remote therapeutic monitoring (RTM) and treat it as a novel digital healthcare which acts as a complementary element for the existing RPM – Remote Physiological Monitoring.
This was recognized when some of the CPT codes introduced this year have many similarities to the CPT codes used for RPM. These CPT codes are scheduled to enhance the extent of codes used for RTM so the scope of reimbursements for non-physiology services provided digitally can be enhanced. Here’s what you need to know so far.
What is remote therapeutic monitoring (RTM)?
The term remote therapeutic monitoring (RTM) is used by the Editorial Panel of CPT codes to cover a set of five codes used for treatment management services rendered in Oct 2020. These approved patient monitoring codes cover a number of individual categories which include self-reported and non-physiologic data such as musculoskeletal system status, respiratory system status, medication response, pain levels, and medication adherence.
The name RTM shows as if CMS might only support remote therapeutic monitoring, but that’s not the case. CMS allows remote monitoring for a variety of non-physiological information. According to the addition of five new CPT RTM codes, physical therapists, speech-language pathologists, occupational therapists, and clinical psychologists will be primary claimers of reimbursements.
What is the difference between RTM and RPM?
While as it is mentioned above that RTM is introduced to support remote physiological monitoring of CPT existing codes. However, there’s a significant difference in both the data used for RTM and RPM. Also, the difference is found in the eligible practitioners who may receive the reimbursements in return for these codes and in the methods of collecting data in remote patient monitoring and remote therapeutic monitoring.
The RTM offers to collect and monitor data to control and observe a wide range of health conditions in place of RPM. In addition, RTM coding associates the service reimbursements which resemble the services offered under RPM but cannot bill the services under RPM’s current CPT codes.
Besides, both approaches use medical devices to monitor data remotely but a significant difference appears in the addition of the self-reported data while using RTM codes. Remote physiological monitoring needs the data and the patients’ records to be automatically extracted from the medical devices and uploaded to the entire patients’ physiological data. On the other hand, RTM data should be self-reported manually in the software by the patients.
The newly introduced RTM codes generally are medicine codes according to the RPM Evaluation and Management services classification. Through this evaluation, many other physicians and qualified healthcare professionals will be able to apply for reimbursement claims who previously were restricted under insurance used for remote patient monitoring.
What are these new CPT codes?
These new five CPT introduced codes are comprised of different uses such as one code (989×1) will be used for equipment training and set-up. Two (989×2 and 989×3) for device codes, and two (989×4 and 989×5) for service or professional work.
According to the CMS-approved RM codes, the descriptions for remote therapeutic codes established by AMA Digital Medicine Payment Advisory are;
- CPT Code 989X1 — RTM (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on the use of equipment
- CPT Code 989X2 — RTM (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
- CPT Code 989X3 — RTM (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
- CPT Code 989X4 — RTM 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)
- CPT Code 989X5 — RTM 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; each additional 20 minutes (List separately in addition to code for primary procedure)
- RTM is used for monitoring non-physiological data from patients using medical devices. According to the new evaluation and addition of RTM CPT codes, ideas such as medication/therapy response, medication/therapy adherence, and medication/therapy for pain levels would be billed and the information will be gathered for reimbursements as well. This was made possible because CMS recognize that therapeutic non-physiological data as the essential category that should be examined under these codes remotely.
- RPM codes on the flip side only work to monitor data by tracing physiologic data such as blood pressure, heart rate, blood sugar, etc.)
- 98976 CPT code is exclusively used for monitoring respiratory services. 98977 can be only used for one healthcare issue – the musculoskeletal system. Although, RTM devices do not cover the information for other systems like vascular, neurological, digestive, endocrine, etc.)
- CMS now allows physicians and many other healthcare professionals such as Physical therapists, Speech-language pathologists, occupational therapists, clinical social workers, and nurse practitioners. Plus, the physical therapists will be accepted as primary billers under these RTM codes.
- For RTM non-physiological data, the use of medical devices is mandatory. These devices should meet the definition defined by the federal Food, Drug, and Cosmetic Act.
- The non-physiological data insertion can be manually added and self-reported by patients or can digital software can be used to upload patients’ information. However, RTM data monitoring would eventually use the medical devices designated by CMS to ensure that the requirements for reimbursements are met. CMS also says that self-reported data using Android or a smartphone app are categorized as Software Medical Devices (SaMD) and can be used for medical reimbursements.