There’s good news on the Medicare-reimbursement front for rehab providers who value patient engagement.
In the CMS 2022 Final Rule published in November, the agency announced that outpatient therapists can bill for monitoring and managing patients even when they’re not in the clinic. They can do so, CMS said, using new CPT codes for “Remote Therapeutic Monitoring.” Here’s a closer look at what these codes are all about and how you can use them over the coming year.
What is Remote Therapeutic Monitoring?
Unlike remote physiological monitoring (RPM), in which technologies are used to electronically transmit vital signs and other physiologic data to a patient’s clinical provider, RTM involves the collection of non-physiologic data. According to CMS, this non-physiologic information may include data pertaining to things like respiratory or musculoskeletal system status, therapy adherence, and therapy response.
With RPM, patient data must be automatically transmitted to the clinician via a connected medical device. With RTM, on the other hand, the data can be manually entered into the connected medical device or self-reported to the clinician by the patient.
What are the RTM Codes?
There are five RTM CPT codes in all, but only four are relevant to PTs, OTs, and speech-language pathologists.
The first two codes are for RTM “services” like supplying monitoring equipment to patients, setting up the devices so they’re ready to use, and teaching patients what their role is when it comes to data collection and reporting. Important to note for these codes: the device used must meet the FDA definition of a medical device; and the codes apply to each episode of care, defined as beginning when the remote therapeutic monitoring service is initiated and ending with the attainment of targeted treatment goals.
- CPT Code 98975: Remote therapeutic monitoring: initial set-up and patient education on use of equipment
- CPT Code 98977: Remote therapeutic monitoring: device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
The next two codes, for RTM “treatment management services,” cover time spent reviewing and monitoring patient data related to signs, symptoms, and response to treatment. These services must be provided by a “qualified” healthcare professional like a PT, OT, or therapy assistant; apply per calendar month; and must include at least one synchronous “interactive communication” between the patient and provider. (Telephone calls and telehealth visits both qualify; direct messaging, for example, does not.)
- CPT Code 98980: Remote therapeutic monitoring treatment management services: first 20 minutes
- CPT Code 98981: Remote therapeutic monitoring treatment management services: each additional 20 minutes
Putting RTM Codes to Work
Here’s just one example of how a practice might leverage RTM codes when billing Medicare:
On January 1, 2022, a patient who was in a motor vehicle accident is seen in the clinic for an initial evaluation, and the therapist develops a plan of care for treatment of injuries to their knee and ankle. Before the patient goes home, the therapist helps them download the Keet app. The therapist also instructs them how to use the app to access educational resources, track their exercise program, and complete patient reported outcomes surveys specific to their plan of care. (The above services can be billed using CPT codes 98975 and 98977.)
Over the next 30 days, the patient uses Keet on a weekly basis to complete their home exercises, review educational content, and complete the relevant patient reported outcome (PRO) surveys. The PT monitors the patient’s progress and adherence while communicating via secure chat and checks in with the patient over the phone between clinic visits. (The above services can be billed using CPT codes 98980 and 98981.)
The Bottom Line
Beginning January 1, 2022, RTM codes will only be recognized by traditional Medicare and Medicare Advantage plans, but it won’t be long before commercial payers follow suit. These codes allow for reimbursement of the technology expenses associated with purchasing and using an application like Keet, and they permit therapists to bill for the work they do with patients outside of the clinic—work therapists are likely already doing.
The exact dollar amount of reimbursement has not yet been finalized, but based on what is known as of now, it’s fair to anticipate that therapists who use the codes could see more than $200 in additional revenue per patient per episode of care.
In today’s world of value-based care, when fee-for-service reimbursement continues to decline, RTM codes are a sign that CMS understands exactly how valuable outpatient rehab therapists really are.
Want to learn more? Watch our on-demand webinar with Keet’s President and GM, Holly Taylor, to learn more about RTM codes, medical devices that qualify, how to bill for RTM, and much more.