With the addition of remote therapeutic monitoring (RTM) to the 2022 CMS physician fee schedule, there’s been a surge of awareness and interest in the term. So, what is remote therapeutic monitoring, exactly, and what does it mean for healthcare providers in the United States?

Looking for reimbursement codes? Get a list of CPT codes for RTM here.

Remote therapeutic monitoring and the benefits of RTM

“…remote therapeutic monitoring, or RTM, refers to the remote delivery of therapeutic patient care … specifically, monitoring a patient’s musculoskeletal status, or respiratory status, as well as related medication and program adherence.

What is remote therapeutic monitoring?

Just as its name suggests, remote therapeutic monitoring, or RTM, refers to the remote delivery of therapeutic patient care. As the RTM codes are currently defined, that specifically means actively monitoring a patient’s musculoskeletal status or respiratory status, as well as medication response and adherence and other key indicators.

Like remote patient monitoring (RPM), RTM can be used to treat a number of chronic health conditions like COPD and cancer. But there are also some big differences between the two care management models.

Take a closer look at CPT codes 98975, 98976, 98977, 98980 & 98981 with our guide to current remote therapeutic monitoring codes.

For healthcare operators and providers, it may be helpful to think of the definition of remote therapeutic monitoring in the terms put forward by the Centers for Medicare & Medicaid Services (CMS). The agency, which drives reimbursement standards for care delivery in the United States, has positioned RTM as a separate model than RPM, and even as a means to supplement and support it.

More specifically, CMS’ remote therapeutic monitoring codes allow reimbursement for the remote managing and collection of non-physiological patient data with qualified devices. As the experts at Foley & Lardner LLP explain, this excludes most consumer-oriented wearables and mHealth devices, and is restricted to medical devices as defined by the U.S. Federal Food, Drug, and Cosmetic Act.

This is in contrast to codes for remote patient monitoring, which reimburse the monitoring of physiological data only. (For this reason, RPM is also sometimes referred to as “remote physiological monitoring.”)

Reimbursement for general (RPM) vs direct supervision (RTM)

Another difference between remote patient monitoring and remote therapeutic monitoring is the classification of the patient data collected. Because they’re reimbursed as “general supervision,” RPM services can be performed by physicians or qualified health care professionals (QHPs) like nurse practitioners or physician assistants, as well as other qualified clinical staff under general supervision.

Remote therapeutic monitoring treatment, on the other hand, offers reimbursement on a “direct supervision” basis. That means that the primary billers of RTM codes can be physical therapists, occupational therapists, speech language therapists, social workers or other clinicians approved to evaluate and bill for RTM services. The eligible practitioner must always be present, even during a virtual check-in.

During the Covid-19 public health emergency (PHE), real-time, audio-visual interactive communication is accepted as direct supervision to meet this requirement. And, although the PHE is set to end in May 2023, some telehealth waivers have been extended through the end of 2024. You can read more about the current reimbursement situation here.

Why RTM represents an expansion of reimbursement for the use of remote monitoring technologies

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Early success stories: Jessica Jaros of Qorum Partners is using RTM to hit new milestones in patient care. Read more about her RTM program here.

The new RTM codes, then, essentially broaden the practical applications of remote patient monitoring technology by expanding how it can be used, and by whom. As such, RTM can be seen as part of CMS’ ongoing expansion of reimbursement codes to better accommodate the delivery of remote care (or telehealth, as per the terminology used by CMS).

What’s the difference between telehealth, RPM and RTM? Find out here.

Used primarily in recent years to manage patients with chronic conditions like COPD or heart disease, remote patient monitoring is now expanding to cover many other patient types. During the Covid-19 PHE, reimbursement has expanded to include other at-risk patients. And there’s informed speculation among industry observers that this expansion is here to stay, as evidenced by the extension of the CMS telehealth waivers well after the PHE ends in May.

What are the benefits of remote therapeutic monitoring?

Beyond the obvious advantages of further enabling at-home care, the therapeutic monitoring treatment management enabled by RTM could benefit providers in other ways. Because they allow for more types of monitoring, for instance, they open the door for reimbursement beyond physician-directed clinical care — the basis for much of the existing RPM billing structure.

And because it allows for the “general medicine” collection of patient data — as opposed to direct “evaluation and management” — the new rule enables more billing practitioners to deliver remote care. And that expands reimbursement beyond the immediate purview of physicians to potentially include nurses, physical therapists, occupational therapists, psychologists, social workers, among others.

RTM also expands remote care usage by allowing patients to self-report data, or to upload info manually to their medical devices. In other words, RTM data can be patient reported as well as digitally uploaded. RPM, on the other hand, has traditionally required that data be uploaded automatically by the device — a requirement that could exclude certain medical devices from qualifying for reimbursement.

What devices are used for remote therapeutic monitoring? Get an overview of RTM devices here.

The upshot of this expanded usage is enabling a closer monitoring of a patient’s adherence to a prescribed therapy. This can let practitioners determine whether patients are following their care regimen, and how effectively it’s working. This, in turn, can help them understand any potential failures of patient adherence, and then make the appropriate adjustments for more effective care.

The more effective monitoring of all of these elements — medication and respiratory system status, therapy adherence, therapy response, respiratory system status and musculoskeletal system status — also has the potential to help providers lower rehospitalization rates or urgent care and ER visits

For instance, the requirement of transmission to monitor musculoskeletal system each 30 days provides clearer insight than ever into a patient’s day-to-day condition. And this could give providers a welcome opportunity to improve outcomes, lower costs, and adhere more closely to the guidelines of value-based care.

Remote therapeutic monitoring and more

If you’re a provider or operator interested in leveraging RTM for the benefit of your patients and practice, check out our companion piece on RTM codes for a detailed breakdown of the reimbursement guidelines, including:

  • CPT code 98975, which covers initial patient setup.
  • CPT codes 98976 and 98977, which reimburse physicians and other qualified health care professionals for the supply of devices and scheduled daily recordings and or programmed alerts.
  • CPT codes 98980 and 98981, which offer reimbursement for time in a calendar month requiring at least one interactive communication with the patient/caregiver, as well as an additional 20 minutes each month, listed separately in addition to codes for primary procedure.

And if you’re seeking guidance on the use of remote care technology, we invite you to download the CareSimple 2022 Reimbursement Tree, a convenient, one-page summary of the 2022 CMS reimbursement codes.

Questions about RTM or other types of remote care? CareSimple is standing by to help answer them. Contact us today to get in touch with one of our experts.