- CPT® 2024 Professional Edition. American Medical Association. p. 875
- Calendar Year 2024 Medicare Physician Fee Schedule, Final Rule. Federal Register, November 2, 2023.
- Calendar Year 2022 Medicare Physician Fee Schedule, Final Rule. Federal Register, November 19, 2021.
- Calendar Year 2021 Medicare Physician Fee Schedule, Final Rule. Federal Register, December 28, 2020
Remote Therapeutic Monitoring (RTM) Coding and Payment
Source: Calendar Year 2024 Medicare Physician Fee Schedule, Final Rule. Federal Register, November 2, 2023.
Medicare Coverage Requirements for Reporting Remote Therapeutic Monitoring (RTM):
- RTM services (e.g., musculoskeletal system status, therapy adherence, therapy response, cognitive behavioral therapy, therapy adherence, therapy response) represent the review and monitoring of data related to signs, symptoms, and functions of a therapeutic response. These data may represent objective device-generated integrated data or subjective inputs reported by a patient. These data are reflective of therapeutic responses that provide a functionally integrative representation of patient status.1
- Physicians and eligible qualified health
care professionals are permitted to bill RTM as general medicine
services. A physician or other qualified health care professional is
defined in the CPT Codebook as “an individual who is qualified by
education, training, licensure/ regulation (when applicable) and
facility privileging (when applicable) who performs a professional
service within his/her scope of practice and independently reports
that professional service.” Accordingly, RTM codes could be
available for physical therapists (PT), occupational therapists
(OT), speech-language pathologists, physician assistants, nurse
practitioners, and clinical social workers.3
- Remote monitoring codes are designated as care
management services and thus CMS’ rules for general supervision
apply to these services. ²
- Billing for remote
monitoring codes requires data collection for at least 16 days in a
30-day period and applies to the following RTM code: 98977. The
16-day data collection requirement does not apply to CPT codes 98980
and 98981 because these CPT codes are treatment management codes
that account for time spent in a calendar month and do not require
16 days of data collection in a 30-day period. ²
report 98975 and 98977 the device used must be a medical device as
defined by the FDA.1
- Only one practitioner can bill for RPM or RTM (not both) during a 30-day period, and only when at least 16 days of data have been collected on at least one medical device. Even when multiple medical devices are provided to a patient, the remote monitoring services associated with all the medical devices can be billed by only one practitioner, only once per patient, per 30-day period, and only when at least 16 days of data have been collected; and that the services must be reasonable and necessary. ²
- For an individual beneficiary who is currently receiving services during a global period, a practitioner may furnish RTM services (but not both RPM or RTM services) to the individual beneficiary, and the practitioner will receive separate payment, so long as the remote monitoring services are unrelated to the diagnosis for which the global procedure is performed, and as long as the purpose of the remote monitoring addresses an episode of care that is separate and distinct from the episode of care for the global procedure - meaning that the remote monitoring services address an underlying condition that is not linked to the global procedure or service.²
- RTM services being furnished during
the global period only applies to billing practitioners who are
receiving the global service payment. Practitioners, such as
physical and occupational therapists, who are not receiving a global
service payment because they did not furnish the global procedure,
would be permitted to furnish RPM or RTM services during a global
- CMS states that self-reported/entered data may be part of the non-physiologic data for purposes of RTM codes. RTM data can be self reported by the patient, as well as digitally uploaded via the device. While RTM codes still require the device used to meet the FDA’s definition of a medical device, self-reported RTM data via a smartphone app or online platform classified as Software as a Medical Device (SaMD) may qualify for reimbursement.3
- Practitioners must obtain consent
either in advance or at the time RTM services are furnished and
document that consent in the patient’s record.4
- For new patients or patients not seen within the
year by billing practitioner, RTM services must be initiated during
an in-person visit.4
- RTM services may be provided to patients with
either acute or chronic conditions.4
Need additional information? Contact Zimmer Biomet’s Reimbursement Hotline by calling 866-946-0444 or via email at Reimbursement@zimmerbiomet.com.
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