Landscape of RTM Billing Codes in 2024

RTM and RPM services have transformed patient care by enabling remote tracking of various health metrics, from vital signs to medication adherence. RTM, in particular, extends beyond the clinic, offering patients support and guidance through various digital means. The American Medical Association (AMA) introduced five CPT codes for RTM services in November 2022, which include codes for both practice expenses and treatment management. Similarly, RPM allows healthcare providers to monitor patients' health data remotely, with its own set of billing codes.

Today some new CMS rulings go into effect and make a much stronger case for physicians, and other MSK providers, to implement RTM into their practice.

Understanding the 2024 Physician Fee Schedule Final Rule

This rule clarifies the requirements for remote therapeutic monitoring services and addresses the time needed for planning, data analysis, and patient interaction. One of the key points is that only one provider can bill for RTM and RPM services over a 30-day period, per episode of care.

Combining RPM and RTM with Other Services

It's important to note that RPM and RTM cannot be billed together in the same month. However, they can be billed concurrently with services like Chronic Care Management (CCM) and Behavioral Health Integration.

New Opportunities for FQHCs and RHCs

The 2024 Physician Fee Schedule has opened doors for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), allowing them to receive reimbursement for RPM and RTM services, albeit with certain limitations.

Breaking Down RTM Billing Codes and Rates for 2024

The CMS has adopted five RTM billing codes covering a range of services from device setup to treatment management. Each code has specific requirements and national average reimbursement rates.

Detailed Breakdown of RTM CPT Codes

1. CPT 98975: This code is used for the initial setup and patient education on the use of the RTM equipment. It is a one-time billing code per 30-day period, applicable only when at least 16 days of data is collected using a medical device. The national average reimbursement rate for this code is around $19.65. It is an essential code for starting RTM services with a new patient or new equipment.
2. CPT 98976: This code specifically applies to respiratory system monitoring. It includes supplying the respiratory device with features like daily scheduled recordings and programmed alerts. Billing for this code can be done every 30 days, provided there's data collection for a minimum of 16 days. The average national payment rate is approximately $46.83.
3. CPT 98977: Similar to 98976, but for musculoskeletal system monitoring devices. It covers devices equipped with features for daily data recording and alerts. Billing conditions are similar to 98976, with the same average national payment rate of about $46.83.
4. CPT 98980: This code is for the first 20 minutes of treatment management services in a calendar month. It includes at least one interactive communication with the patient. This code can be billed under general supervision and is applicable for physicians, nurse practitioners, and physician assistants. The average national payment rate for CPT 98980 is around $49.78.
5. CPT 98981: This code is an extension of 98980, covering each additional 20 minutes of treatment time within the same calendar month. The requirements for billing this code are the same as for 98980. The average national payment rate for CPT 98981 is approximately $39.30.

Key Points for Healthcare Providers

• Billing Restrictions: Each of these codes can only be billed once per clinician over a 30-day period, per episode of care.
• Supervision Requirements: For CPT codes 98980 and 98981, the services must be furnished by the billing qualified health care practitioner. This also includes provisions for supervised practitioners like NPs and PAs which make it a more feasible billing option.

For healthcare providers, understanding the nuances of RPM and RTM billing codes is crucial. These codes are distinct, with specific rules and reimbursement rates. As the landscape of remote monitoring evolves, staying ahead of these changes ensures effective service delivery and billing practices.

Follow Shasta Health for more updates and insights into the often cloudy world of healthcare billing and reimbursement. Our aim is to keep you informed and ahead in delivering high quality patient care.