Remote Therapeutic Monitoring
Remote monitoring helps healthcare professionals understand how the patient is progressing during recovery and helps the patient access and receive better care at a lower cost. The largest benefit is the increased volume and timeliness of information available to healthcare professionals and patients, which can help with medical discussions and decisions.
Example: A total knee arthroplasty (TKA) patient who is walking frequently and well at four weeks after surgery and lives two hours from the physician’s office may be able to check-in via telephone instead of driving to the office.
Current procedural terminology (CPT) codes were established for Remote Therapeutic Monitoring (RTM) starting January 1, 2022.
Definition: RTM is remote monitoring and management of therapy services, for example, monitoring of respiratory or musculoskeletal status, and medication and therapy adherence and response. RTM involves remote managing and collection of non-physiological patient data.
- The medical device must be cleared by the Food and Drug Administration (FDA).
- RTM data can be objective device-generated data or it can be subjective inputs reported by a patient. Patient consent must be obtained at the time the remote monitoring services are furnished.
- There must be an established patient-physician relationship.
- RTM may be provided under general supervision and is a General Medicine code.
Billing Code Details:
|RTM CPT CODE||Description||Requirements||2023 CMS
|98975||Practice expense code. Setup. Service Initiation / Patient Education. Billed one time per patient.||Patient consent to participate; Base station transmitting data.||$16 – $27|
|98977||Practice expense code for supply of remote device for musculoskeletal system. Billed once each 30 days.||Data must be collected for a minimum of 16 of the 30 days.||$42 – $70|
|98980||Professional code. Care / treatment management. Remote monitoring treatment management services, first 20 minutes of qualified HCP time in a calendar month. Billed once per month.||Interactive communication between the patient and HCP is required. Total time, including data review, discussion, physician review, scheduling, is at least 20 minutes.||$45 – $62|
|98981||Professional code. Care / treatment management. Remote monitoring treatment management services, each additional 20 minutes of qualified HCP time in a calendar month. Billed up to 2x per month.||Interactive communication between the patient and HCP is required. Total time, including data review, discussion, physician review, scheduling, is at least 40 minutes (first billing) or 60 minutes (2nd billing).||$36 – $51|
*Note, the Centers for Medicare and Medicaid update the physician fee schedule quarterly and fees vary depending on location, cost of living and quality measure reporting. To find local payment information, go to https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched. Values shown in this chart are sourced from the January 2023 update to the physician fee schedule, accessed March 30, 2023.
Billing for private insurance:
Check with the patient’s insurance company for information on their billing and reimbursement policies. Depending on the patient’s insurance, they may have a copay.
Billing for Medicaid:
Each state has its own remote patient monitoring billing and reimbursement policies. Healthcare Professionals can check their state’s policies at the National Policy Center – Center for Connected Health Policy at https://www.cchpca.org/topic/remote-patient-monitoring/.
The summary information contained herein is for information purposes only and, in all instances, is subject to the specific requirements set forth in applicable laws and regulations. Nothing herein is intended to, or shall, constitute medical advice. Each healthcare professional must use his or her own medical judgment and expertise with respect to all decisions pertaining to medical treatment and/or care of patients under his or her care.
- CMS policy for RTM, www.cms.gov/files/document/r11118cp.pdf, accessed May 31, 2023.
- CMS Clarifies Payment for Remote Therapeutic Monitoring Services – McDermott (mwe.com), accessed May 31, 2023.