RTM Billing

What is Remote Therapeutic Monitoring (RTM)?

Although Remote Therapeutic Monitoring (RTM) services cover digital monitoring of health conditions, including the musculoskeletal system, respiratory system, therapy (medication) adherence, and therapy (medication). RTM is intended for the management of patients utilizing medical devices that collect non-physiological data.

With the advent of RTM, a new set of Billing Codes have been implemented and are in the process of being refined by the Centers for Medicare & Medicaid Services (“CMS”). These codes are targeted at providing reimbursement for clinicians spending time in the provision of medical devices that can track patient information over time, and the review of the resulting information.

The New RTM CPT Codes

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.  

Learn more about each of the 5 new codes below.

Device Education and Onboarding (CPT Code 98975)

CPT code 98975 covers: Remote therapeutic monitoring 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 98977)

CPT Code 98977 covers: 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.

How to use these codes: Report 98977 only if monitoring a patient’s musculoskeletal system. 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 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. 

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.

What payers will reimburse for RTM billing codes?

The landscape of reimbursement for RTM continues to change, but the more these codes are used the better we will understand reimbursement. The American Medical Association has recently published a research brief that details which codes many providers will pay for, including Aetna, Cigna, and many Blue Cross Blue Shield regions. You can download the AMA's research brief by visiting the AMA website.

As always, we recommend working with your organization to determine the right approach to any billing decisions.