If there’s one topic that’s guaranteed to make a physical therapist’s eyes glaze over, it would have to be CPT codes. This is why what we’re about to say next may come as a bit of a surprise.
A new set of CPT codes from CMS is going to change the physical therapy industry.
Introduced with the agency’s 2022 Final Rule, the new codes are for remote therapeutic monitoring (RTM)—the use of patient-engagement technologies to monitor and communicate with patients outside the walls of the clinic. What’s exciting about the codes isn’t the fact that they’re meant to encourage therapists to embrace remote care. Instead, it’s that now—at long last—therapists can bill Medicare for exactly the kind of work that many have considered essential to achieving good clinical outcomes for years.
The biggest immediate impact of this shift will be obvious to most PT practices: For those that decide to leverage the codes, you’ll see an increase in revenue. Even more important, though, these “RTM” codes are a sign that CMS recognizes the critical role that outpatient rehab therapy plays in the larger healthcare ecosystem. The agency is pushing for wider adoption of digital health, but it’s also pushing for more physical therapy both in the clinic and from afar.
A New Source of Revenue
First up, the reimbursement front: The five new codes (four apply to MSK) allow practices to bill Medicare and Medicaid Advantage plans when they use a single digital health platform to collect and review patient data pertaining to therapy adherence and response to treatment. For practices that are already using Keet, the requirements align with what you’re doing now. You simply show patients what the app is all about, and you ask them to use it between in-person appointments to follow their plan of care and submit patient-reported outcomes surveys. In the end, you can bill Medicare for the time you spend showing patients how to use the technology and for the “treatment management services” you provide via remote monitoring.
CMS introduced RTM codes in part because it recognized how remote physiological monitoring (RPM)—the electronic transmission of physiologic data like blood pressure, for example—had helped many providers care for patients during the pandemic. Physicians were (and still are) able to bill for that work using a set of RPM codes. RTM codes are different, but their purpose is the same: to compensate providers for the work they do care for patients outside of the clinic.
A New Direction for Outpatient Therapy
So how is this a game-changer for physical therapy? For that, it helps to take a step back and consider where healthcare is headed.
As any PT who uses Keet knows well, CMS has trained its focus on value-based care for the better part of the last seven years. With programs like MIPS and alternative payment models, the agency is increasingly rewarding clinicians who can show they provide quality, cost-effective care. Success in these initiatives depends on the provider’s performance across a number of outcomes measures, and for physical therapists, it depends on patient engagement—providing patients with the tools they need to support their recovery outside the clinic walls.
The new RTM codes are definitely a chance for practices to create revenue streams they didn’t have before. But they’re also a message from CMS that remote therapeutic monitoring—and therefore physical therapy—is a valuable component in the transition to value-based care.
With value-based care gathering steam and RTM codes in play, we expect to see many more PT practices signing on to programs like MIPS. We also anticipate that physical therapists will increasingly partner with orthopedic surgeons and primary care providers in their communities to build new value-based programs focused on musculoskeletal care.
Finally, the introduction of RTM codes is aligned with other CMS initiatives intended to extend the capacity of providers to care for more patients under population health management approaches. By some estimates, less than 10 percent of people who need physical therapy are actually getting it. Perhaps remote therapeutic monitoring will become a way for practices to meet patients where they are when they can’t make it to the clinic.
Looking ahead to the remainder of 2022, it seems clear to us that RTM codes will be a welcome source of income for practices in a world where fee-for-service reimbursement is declining all the time. Beyond that, only one thing’s for certain: opportunities abound.