Remote Reimbursement for Therapeutic Monitoring in 2022

The healthcare industry has faced a plethora of advancements throughout the years. With these technologies, we can provide medical care even without sharing a physical space. Last November 2, 2021, the Centers for Medicare and Medicaid Services or CMS finalized the Medicare Physician Fee Schedule for Calendar Year 2022. This is also called the Final 2022 MPFS or the Final Rule. 

Previously in July, the CMS proposed creating new CPT codes and associated opportunities for reimbursement for those getting Remote Therapeutic Monitoring or RTM. This encompasses the monitoring and collection of “therapy adherence” and “therapy response” with “treatment management services.”

Proposed Changes on CPT Codes

Circling back to the proposed 2022 MPS, the CMS stated their concern on how RTM CPT codes were structured by the American Medical Association’s CPOT committee and asked stakeholders’ feedback regarding the RTM code construction. Here, Nixon Gwilt Law provided a framework to align the services and code structures used for RTM and Remote Patient Monitoring. 

Although the CMS in the Final Rule has integrated important portions in the framework like expanding patient data captured and analyzed through remote monitoring and different practitioners who can order and bill for, it has stopped aligning RTM and RPM. With that, they wish to engage with stakeholders interested in the coding efficiency of their service, such as AMA CPT, to refine coding for RTM services. 

This change leaves room for hope that remote patient monitoring stakeholders won’t be forced to wait another year for policy improvements regarding RPM and RTM. 

Different Codes Finalized for the Final Rule

  • Remote Therapeutic Monitoring CPT Codes: These general medicine codes are billable by practitioners who aren’t eligible, besides providers eligible to bill E/M services. 
  • Initial Set-up and Patient Education: This is CPT code 98975, covering initial setup and patient education on the use of equipment.
  • Supply of Device for Monitoring Respiratory System: This is CPT code 98976 that covers respiratory system status that offers scheduled recordings and programmed alerts every 30 days. 
  • Supply Device for Monitoring Musculoskeletal System: This is CPT code 98977 that covers scheduled recordings and alerts for monitoring the musculoskeletal system every 30 days.
  • Monitoring/Treatment Management Service (First 20 Minutes): This is CPT code 98980, which monitors the treatment management services and monitors qualified health care professionals’ time requiring interactive communication with a patient for the first 20 minutes. 
  • Monitoring/Treatment Management Services (Additional 20 Minutes): This is CPT code 98981 and covers interactive communication and services during a calendar month in addition to the first 20 minutes. 

The Bottom Line: What’s Next for RTM and RPM?

Now that the CMS has begun processing and aligning the RPM and RTM codes to reach dual goals of both types of patient data, professionals have more data to use for remote monitoring treatment management services and those who can order and bill for these services. However, there’s much room for improvement. 

How Can We Help You?

From chronic conditions to behavioural health conditions, down to needing to transition out of an inpatient facility, Medistics Health is here to simplify the experience. If you’re interested to learn more about remote patient monitoring, reach out to us today!

Profit Calculator Assumptions: 40% of total Medicare patients enrolling is based on (i) Medicare Chart Book’s data showing that ~68% of medicare patients qualify for CCM (2 or more chronic conditions), and (ii) that ~40% of eligible patients will enroll.

For typical providers, $46.67 of net profit per patient per month is based on a Medicare reimbursement per patient per month (national average) for various care management CPT codes.

CPT and other codes, descriptions and other data are copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).