Remote Therapeutic Monitoring: FAQs

CPT codes can be billed if the requirements are met by a therapist to any insurance plan. The key thing to note is whether the insurance reimburses, is changing all the time. The number of Commercial insurance companies progressively adopting the practice of recognizing these codes continues to grow. Given that the Medicare, Med-Advantage, and Medicaid insurance plans fall directly under CMS ruling, they have been the first to adopt reimbursement for RTM codes 100% of the time. This is a great starting point when implementing an RTM program, with a plan to branch out to other insurance payers.

With the continual integration of technology in the healthcare industry, the formation of RTM codes is a first step towards billable hybrid care. That being said, RTM should be a consideration for all therapy companies. Currently, when factoring only the above-mentioned insurances, clinics are demonstrating an ROI value in RTM implementation when these insurances make up 15-20% of their caseload.

If your therapists already engage their patients with a well-designed, progressive HEP and expect compliance, it is worth noting that no extra time is required to bill 98975/98977. All that is required is an efficient workflow and attention by the therapist.

Your therapists likely field client emails, phone calls, modify the existing HEP and issue additional educational materials in their already busy day. By appropriately documenting these once non-billable tasks, 98980/81 may be eligible to bill. With an effective workflow, you can estimate around 1 hour of time per month/per PT. This time can be allocated in a myriad of different ways according to your unique clinic.

If timing and compliance worked out to bill 98975 once, 98977/98980/98981 twice in a two month POC (eval to discharge), you could expect an additional reimbursement of approximately $240-$260 for this patient.

There are many factors at play when assessing this. Taking reimbursement amounts only from Medicare, standardizing for a plan of care of 3 months, factoring percentage of each code billed when looking at compliance during a 3 month POC, and with an effective workflow in place. It is reasonable to expect $140-$160 additional reimbursement per patient.

It is reasonable to be fully implemented and billing RTM CPT codes in 4-6 weeks. This would include the following:

Yes, assistants bill these codes, however the reduction in reimbursement for the assistant does apply for 98975, 98980/81 (with a 10% de minimis rule).

Currently only Physicians, Physical Therapists, Occupational Therapists, Speech Language Pathologists, Respiratory Therapists (and assistants) can bill RTM CPT codes.

Physiotec’s team of experienced physical therapists and legal professionals will continue to stay abreast of the latest CMS guidelines, translating them into actionable steps in your clinic to keep you compliant within implementation and beyond.