You can now get paid more for using digital health technology with your patients. As of January 1st, new codes for Remote Therapeutic Monitoring (RTM) allow you to get reimbursed for monitoring non-physiologic data.
These codes opened up more patient care options, allowing your practice to use newer technology and still get reimbursed for it.
RTM-Qualified Devices
To qualify as an RTM device, it must be defined under the federal Food, Drug, and Cosmetics Act as a medical device. Wellness devices, such as wearable watches that monitor respiratory rate and heart rate, do not qualify for reimbursement under RTM codes.
These devices do not need to automatically record and upload data to qualify for RTM; this is a major difference between the RTM codes and the codes for Remote Physiologic Monitoring (RPM).
Patients can self-report their data, including by using a smartphone app or online platform that’s qualified as Software as a Medical Device (SaMD). However, most devices that qualify for RTM do also record data that can be uploaded.
Devices used for RTM services are meant to track information such as respiratory system status, musculoskeletal system status, therapy adherence, and therapy response.
If taking medication on a schedule is part of a patient’s treatment protocol, for example, a smart pill dispenser may be considered a reimbursable RTM device under the new code set.
RTM Codes
The new code set includes five individual codes: One for the setup and education of RTM devices, two device codes, and two service codes. This setup is similar to the codes that govern RPM services.
The five RTM codes are:
- CPT code 989X4: RTM treatment management services by a physician or other qualified healthcare professional requiring at least one interactive communication with the patient/caregiver during a calendar month, first 20 minutes.
- CPT code 989X5: RTM treatment management services by a physician or other qualified healthcare professional requiring at least one interactive communication with the patient/caregiver during a calendar month, each additional 20 minutes. This code is to be listed separately in addition to the code for the primary procedure.
- CPT code 989X1: RTM initial set-up and patient education on the use of the equipment.
- CPT code 989X2: RTM device(s) supply with scheduled (ie, daily) recording and/or programmed alert transmission to monitor the respiratory system, each 30 days.
- CPT code 989X3: RTM device(s) supply with scheduled (ie, daily) recording and/or programmed alert transmission to monitor the musculoskeletal system, each 30 days.
These codes are classified as general medicine codes and not E/M codes. RPM codes are still classified as E/M codes.
RTM vs. RPM
Understanding what qualifies as RTM and how it’s different from RPM services is one of the key factors in offering reimbursable RTM services in your practice.
The differences between RTM and RPM come down to four main characteristics:
- Nature of Data: RTM codes allow for non-physiological data to be collected. RPM codes, on the other hand, are only used for physiologic data.
- Clinical Use Cases: RTM codes are only for devices that monitor the respiratory or musculoskeletal systems. RPM codes do not restrict the clinical or biological systems being monitored, as long as the data collected is physiological.
- How Data Is Collected: Both RTM and RPM require the use of a medical device. However, RTM data can be self-reported by the patient or uploaded digitally from the device. RPM data, however, is required to be automatically recorded and uploaded from the device.
- Which Clinicians Can Order and Bill: With RPM services, incident-to billing for clinical staff is allowable since they are E/M codes. RTM services, on the other hand, are general medicine codes and the services must be furnished directly by the billing practitioner. This means that, if a PT or OT is billing the services, they must also be the ones providing the services to the patient.
This new set of services opens up a broader spectrum of care for your practice and, as a result, potential new revenue streams to boost your billing.
Understanding the differences between RPM and RTM services, and who can and cannot provide each type, is confusing. But you can bill for both types of services in your practice as long as all conditions are met. To get more strategies for billing RPM and RTM services, check out Healthcare Training Leader’s immediately available online training, Remote Patient Monitoring, 2022 Updates. In this 60-minute training, Michael Stearns, MD, CPC, CFPC, CRC, gives you step-by-step guidance on these complicated code sets. Access this training today!
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