Remote Therapeutic Monitoring (RTM) Coding and Payment

Source:https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule

Medicare Coverage Requirements for Reporting Remote Therapeutic Monitoring (RTM):

  • RTM services (e.g., musculoskeletal system status, therapy adherence, therapy response) represent the review and monitoring of data related to signs, symptoms and functions of a therapeutic response. These data are reflective of therapeutic responses that provide a functionally integrative representation of patient status.2
  • 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
  • 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 the 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
  • Code 98975 may be billed once per episode of care. An episode of care begins when the remote therapeutic monitoring service initiates and ends with the attainment of targeted treatment goals. Code 98977 may be billed once per 30 days. Code 98980 may be billed once per calendar month regardless of the number of therapeutic monitoring modalities performed in a given calendar month. Code 98981 may be billed once per calendar month for each additional 20 minutes of services completed within such month.2
  • CPT codes 98975 and 98977 require the RTM device to monitor at least 16 days of data per each 30-day period, in total.2
  • 医疗设备提供给病人作为of CPT code 98977 must be a medical device as defined by Section 201(h) of the Federal Food, Drug and Cosmetic Act.3
  • In the CY 2022 Medicare Physician Fee Schedule Final Rule, CMS stated 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

Additional Information

Need additional information? Contact Zimmer Biomet’s Reimbursement Hotline by calling 866-946-0444 or via email atReimbursement@zimmerbiomet.com.

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