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What is RTM?
Remote Therapeutic Monitoring (RTM) refers to the use of digital technologies to gather therapeutic adherence and/or therapeutic response data from patients in one location and transmit that information to healthcare providers in another location for analysis.
What are the RTM codes?
The American Medical Association (“AMA”) CPT Professional 2023 (the “CPT Codebook”) describes the RTM CPT codes as follows. Corresponding reimbursement amounts represent currently available National Payment Non-Facility payment rates under Medicare.
- CPT code 98975 ($19*): (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment)
- CPT code 98977 ($50*): (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days)
- CPT code 98980 ($49*): (Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes)
- CPT code 98981 ($39*): (Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes)
*Please Note: Reimbursement amounts listed represent a national average; exact reimbursement amounts vary by geographic region. Amounts are based on CMS 2023 non-facility pay rate and are subject to change.
Does Medicare require patient copays for RTM services?
Yes. As with all Medicare services, patients are responsible for all applicable copayments and cost-sharing amounts. Medicare Part B beneficiaries are typically responsible for a 20% copay each time a code is billed, and for 2023, Medicare Part B beneficiaries are also responsible for a $226 annual deductible. Commercial payers may or may not, at their option, require a copay for services.
Does CMS require certain documentation when billing RTM Codes?
Yes. CMS requires that patient consent be documented in the medical record. Providers should continue to follow current billing practices and ensure that all billing requirements for each code are met, such as documenting medical necessity.
How can I find the most up-to-date reimbursement amounts for the RTM codes?
You can confirm current Medicare reimbursement amounts by searching for the relevant RTM CPT code, including a breakdown of payment amounts by geography, at CMS Fee Schedule. Commercial payer reimbursement varies by payer, plan, and geography. Please confirm with each contracted payer.
For more questions please contact us.
Remote Therapeutic Monitoring
What is RTM?
Remote Therapeutic Monitoring (RTM) refers to the use of digital technologies to gather therapeutic adherence and/or therapeutic response data from patients in one location and transmit that information to healthcare providers in another location for analysis.
What are the RTM codes?
The American Medical Association (“AMA”) CPT Professional 2023 (the “CPT Codebook”) describes the RTM CPT codes as follows. Corresponding reimbursement amounts represent currently available National Payment Non-Facility payment rates under Medicare.
- CPT code 98975 ($19*): (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment)
- CPT code 98977 ($50*): (Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days)
- CPT code 98980 ($49*): (Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes)
- CPT code 98981 ($39*): (Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes)
*Please Note: Reimbursement amounts listed represent a national average; exact reimbursement amounts vary by geographic region. Amounts are based on CMS 2023 non-facility pay rate and are subject to change.
Does Medicare require patient copays for RTM services?
Yes. As with all Medicare services, patients are responsible for all applicable copayments and cost-sharing amounts. Medicare Part B beneficiaries are typically responsible for a 20% copay each time a code is billed, and for 2023, Medicare Part B beneficiaries are also responsible for a $226 annual deductible. Commercial payers may or may not, at their option, require a copay for services.
Does CMS require certain documentation when billing RTM Codes?
Yes. CMS requires that patient consent be documented in the medical record. Providers should continue to follow current billing practices and ensure that all billing requirements for each code are met, such as documenting medical necessity.
How can I find the most up-to-date reimbursement amounts for the RTM codes?
You can confirm current Medicare reimbursement amounts by searching for the relevant RTM CPT code, including a breakdown of payment amounts by geography, at CMS Fee Schedule. Commercial payer reimbursement varies by payer, plan, and geography. Please confirm with each contracted payer.