New Reimbursement for Remote Therapeutic Monitoring in the Final 2022 Medicare Physician Fee Schedule
On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) finalized the Medicare Physician Fee Schedule for Calendar Year 2022 (the “Final 2022 MPFS” or the “Final Rule”). As we noted in our July article discussing the Proposed 2022 MPFS, CMS proposed creating five new CPT codes and associated opportunities for reimbursement for Remote Therapeutic Monitoring (“RTM”), which encompasses the collection and monitoring of “therapy adherence” and “therapy response” data along with “treatment management services.” CMS distinguishes RTM from Remote Physiologic Monitoring (“RPM”), finalized in 2019, noting that RTM allows for patient self-reported data and may be ordered/billed by practitioners who are not eligible to order/bill for RPM.
In its Proposed 2022 MPFS, CMS noted concerns around how the RTM CPT codes were structured by the American Medical Association’s CPT Committee and requested stakeholder feedback “on how [they] might remedy the issues related to the RTM code construction.” Nixon Gwilt Law took CMS up on its invitation and provided a framework to fully align the services and code structures for Remote Patient Monitoring and Remote Therapeutic Monitoring.
While CMS in the Final Rule explicitly adopted important portions of this framework by expanding 1) the types of patient data captured and analyzed for remote monitoring, and 2) the types of practitioners who can order and bill for remote monitoring, it stopped short of fully aligning RPM and RTM, stating: “In the interest of coding efficiency for these services, we hope to continue to engage in dialogue with stakeholders, including the AMA CPT, in the immediate future on how best to refine the coding for the RTM services to address some of the specific concerns raised by stakeholders.” This language leaves room for hope that remote patient monitoring stakeholders will not be forced to wait another full year for improvements to policy around RPM and RTM.
Below is a look at the codes as finalized for reimbursement in the Final Rule, followed by some key takeaways around the implications for digital health companies.
Remote Therapeutic Monitoring CPT codes
Unlike the Remote Physiologic Monitoring code set categorized as Evaluation and Management (“E/M”) codes in the CPT Manual, the five codes finalized for Remote Therapeutic Monitoring are general Medicine codes, billable by practitioners who are not eligible, in addition to providers who are eligible to bill E/M services.
Initial Set-up and Patient Education: CPT code 98975 (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)
Supply of Device for Monitoring Respiratory System: CPT code 98976 (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 respiratory system, each 30 days)
Supply of Device for Monitoring Musculoskeletal System: CPT code 98977 (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)
Monitoring/Treatment Management Services, first 20 minutes: CPT code 98980 (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)
Monitoring/Treatment Management Services, each additional 20 minutes: CPT code 98981 (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 (List separately in addition to code for primary procedure))
Frequently Asked Questions about Remote Therapeutic Monitoring
What types of patient data can be monitored using the RTM codes?
In its Final Rule, CMS discusses RTM in the context of “therapy adherence” and “therapy response.” CMS further references monitoring of “health conditions, including musculoskeletal system status, respiratory system status,” where “non-physiologic data” is collected. While “health conditions” can be interpreted broadly, the focus on “musculoskeletal system status” and “respiratory system status” comes into play with the two device codes, which may be interpreted as limiting reimbursement for “device supply” to devices related solely to those two systems. CMS should rectify this with a system-agnostic device code as soon as possible to allow reimbursement for RTM services beyond monitoring patients’ musculoskeletal and respiratory systems.
Who can order and bill for Remote Therapeutic Monitoring?
Unlike the RPM codes, RTM services are available to Qualified Health Care Practitioners (“QHCPs”) who are not able to independently order and bill for E/M services. This is great news for physical therapists, occupational therapists, clinical psychologists, and other QHCPs who are eligible to bill the general Medicine codes. These practitioners can now order and bill the RTM codes without the need for a physician or Non-Physician Practitioner (“NPP”) subject to state scope of practice and supervision requirements, expanding available use cases for RTM considerably.
Does clinical staff time count towards the monthly 20 minutes of monitoring for the RTM treatment management codes?
While the E/M RPM care management codes explicitly allow clinical staff time to be billed “incident to” the services of a physician, nurse practitioner, or physician assistant, the RTM codes are classified in the CPT Manual as Medicine codes -- meaning they are available to Physicians, NPPs and other QHCPs, but that “where the practitioner’s Medicare benefit does not include services furnished incident to their professional services, the items and services described by these codes must be furnished directly by the billing practitioner or, in the case of a PT or OT, by a therapy assistant under the PT’s or OT’s supervision.” While this language would seem to indicate that CMS intends to allow clinical staff time for treatment management to be billed incident-to when RTM is ordered by MDs/NPPs, the code descriptors for the treatment management codes reference only “physician/ other qualified health care professional time.” This is in contrast to the code descriptors for the RPM treatment management codes, which explicitly allow for clinical staff time to count towards the 20 minutes of required time each month. We will hope for clarity from CMS around this issue in the near future.
What kinds of devices can be used for Remote Therapeutic Monitoring?
Like the requirement set forth in the RPM codes, any devices used for RTM must meet the FDA’s definition of a medical device (as opposed to, for example, a general wellness device). Unlike RPM, however, patient self-reported data can be collected and transmitted via Software as a Medical Device in addition to standalone peripheral devices. While the RTM treatment management codes as finalized are not limited to use cases relating to musculoskeletal or respiratory systems, the two “device supply” codes specifically refer to musculoskeletal or respiratory devices, leaving significantly less reimbursement opportunities for devices that do not fit into one category or the other.
Are the RTM codes reimbursed at the same rate as the RPM codes?
In the 2022 Final Rule, CMS reiterated its intent to maintain payment parity between the RPM and RTM treatment management codes. CMS also “cross-walked” the Practice Expense RVUs for the RTM codes for initial setup/patient education and supply of device to the corresponding RPM codes.
What’s next for RPM and RTM?
While CMS has clearly begun the process of aligning the RPM and RTM codes to achieve the dual goals of both expanding the types of patient data that can be utilized for remote monitoring treatment management services and expanding the types of practitioners who can order and bill for these services, there is more work to be done. The Final 2022 MPFS specifically references the suggestions Nixon Gwilt Law made for improving both RPM and RTM codes as set forth in our article and submitted to CMS as formal comments, and goes on to note that CMS is open to working directly with stakeholders to continue to improve the current RTM structure. We believe the door is open for additional changes in the near term, and we'll be working to facilitate meetings directly with CMS for our clients in the RPM/RTM space. This opportunity is good news for practitioners and digital health companies alike – and most importantly, for patients.