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Which CPT Codes are Used in Remote Therapeutic Monitoring Billing?

Remote Therapeutic Monitoring CPT Codes

Remote Therapeutic Monitoring (RTM) has become an increasingly important part of modern healthcare delivery, especially since the COVID-19 pandemic highlighted the need for remote care options. If you’re a healthcare provider looking to implement RTM services or just trying to understand the Remote Therapeutic Monitoring billing landscape better, you’re in the right place.

Let’s break down everything you need to know about RTM CPT codes and how they work.

What is Remote Therapeutic Monitoring?

Before we dive into the specific codes, let’s get clear on what RTM actually is. Remote Therapeutic Monitoring refers to the collection and analysis of non-physiological data related to a patient’s health status.

This might include:

  • Medication adherence
  • Response to therapy
  • Exercise adherence
  • Pain levels
  • Respiratory system status
  • Musculoskeletal system status

Unlike Remote Patient Monitoring (RPM), which focuses on physiological data like blood pressure or blood sugar levels, RTM centers on therapeutic data and response to prescribed therapies.

The Core RTM CPT Codes

Device Supply and Setup Codes

CPT 98975

  • Initial setup and patient education for RTM device(s)
  • One-time billing per episode of care
  • Requires medical device as defined by the FDA
  • Cannot be reported for software only
  • Typical time: 20 minutes

Practice tip: Document the specific device(s) used, setup process, and patient education provided in your notes.

Data Collection and Transmission Codes

CPT 98976

  • Device supply with scheduled recordings/programmed alerts
  • Specifically for respiratory system monitoring
  • Reported once for each 30-day period
  • Device must be used for minimum of 16 days to bill

CPT 98977

  • Device supply with scheduled recordings/programmed alerts
  • Specifically for musculoskeletal system monitoring
  • Reported once for each 30-day period
  • Device must be used for minimum of 16 days to bill

Practice tip: Ensure your documentation includes the specific system being monitored and the number of days the device was actually used.

Treatment Management Codes

CPT 98980

  • First 20 minutes of treatment management services
  • Calendar month of provider time
  • Interactive communication with patient/caregiver required
  • Must document time spent

CPT 98981

  • Each additional 20 minutes of treatment management services
  • Used in conjunction with 98980
  • Maximum of 40 minutes additional time (2 units)
  • Must document time spent

Key Billing Requirements and Guidelines

General Requirements for RTM Services

Ordering Requirements

  • Valid order from treating provider
  • Clear medical necessity documentation
  • Specific therapeutic goals identified

Patient Consent

  •  Written or verbal consent required
  • Must be documented in medical record
  • Annual renewal recommended

Device Requirements

  • Must be FDA-defined medical device
  • Capability for daily recordings or programmed alerts
  • Data transmission must be automatic (not patient self-recording)

Time Documentation Requirements

When billing for treatment management services (98980, 98981), you must document:

  • Total time spent during calendar month
  • Nature of interactive communication with patient
  • Clinical staff time vs. qualified healthcare professional time
  • Summary of management changes or decisions made

Common Clinical Applications

Respiratory Monitoring

  • Asthma management
  • COPD monitoring
  • Sleep apnea therapy adherence
  • Inhaler technique and usage tracking

Example scenario: A COPD patient uses a smart inhaler that tracks medication usage patterns and technique. The device transmits data about inhaler use, helping providers adjust therapy based on adherence and effectiveness.

Musculoskeletal Monitoring

  • Post-operative recovery tracking
  • Physical therapy progress monitoring
  • Pain management assessment
  • Exercise adherence tracking

Example scenario: A post-knee replacement patient uses a motion sensor device to track exercise adherence and range of motion progress during home therapy.

Medication Adherence

  • Therapy response tracking
  • Side effect monitoring
  • Dosing schedule adherence
  • Patient engagement tracking

Reimbursement Considerations

Payment Requirements

Device Supply Codes (98976, 98977)

  • 16 days minimum usage per 30-day period
  • One unit per 30-day period
  • Cannot bill multiple units for multiple devices

Treatment Management Codes (98980, 98981)

  • Calendar month billing
  • Interactive communication required
  • Time-based billing rules apply
  • Non-face-to-face services included

Common Reimbursement Challenges

Documentation Gaps

  • Insufficient time documentation
  • Missing medical necessity
  • Incomplete device usage records

Coding Errors

  • Incorrect code selection
  • Improper time calculations
  • Missing required elements

Billing Mistakes

  • Wrong date of service
  • Incorrect units
  • Missing modifiers when required

Best Practices for RTM Implementation

Program Setup

Patient Selection

  • Identify appropriate candidates
  • Document medical necessity
  • Assess technical capabilities
  • Evaluate support system

Staff Training

  • Device setup and troubleshooting
  • Documentation requirements
  • Billing procedures
  • Patient education protocols

Workflow Integration

  • Define roles and responsibilities
    Establish monitoring protocols
  • Create communication procedures
  • Develop intervention guidelines

Documentation Excellence

Initial Setup

  • Device details and serial numbers
  • Patient education provided
  • Consent obtained
  • Treatment goals established

Ongoing Monitoring

  • Data collection dates
  • Device usage compliance
  • Clinical interventions
  • Patient communication

Treatment Management

  • Time spent on services
  • Clinical decision making
  • Care plan modifications
  • Patient response

Common Mistakes to Avoid

Billing Errors

  • Billing before 16 days of use
  • Double-billing device supply
  • Incorrect time calculations
  • Missing documentation

Clinical Mistakes

  • Poor patient selection
  • Inadequate training
  • Insufficient monitoring
  • Delayed interventions

Documentation Failures

  • Missing consent
  • Incomplete time records
  • Poor medical necessity documentation
  • Inadequate intervention records

Future of RTM

The landscape of Remote Therapeutic Monitoring is continuously evolving.

Keep an eye on:

Technology Advances

  • New device development
  • Enhanced data analytics
  • Improved patient interfaces
  • Better integration capabilities

Regulatory Changes

  • Updated coding guidelines
  • New coverage policies
  • Modified documentation requirements
  • Expanded eligible services

Clinical Applications

  • New therapeutic areas
  • Enhanced monitoring capabilities
  • Improved intervention strategies
  • Better outcome tracking

Summary

Remote Therapeutic Monitoring represents a significant opportunity to enhance patient care while maintaining appropriate reimbursement for services.

Success with RTM requires:

  • Understanding and proper use of CPT codes
  • Thorough documentation practices
  • Appropriate patient selection
  • Effective program implementation
  • Ongoing monitoring and adjustment

Always verify specific requirements with your local Medicare Administrative Contractor (MAC) and commercial payers before implementing new services.

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