Medicare

RTM may be a beneficial option for any practice delivering healthcare for those experiencing certain chronic conditions. Hero provides clinicians with objective data on their patients’ medication adherence to help enable informed care decisions and open conversations with patients.

According to the CMS 2021 final rule, Remote Physiologic Monitoring codes involve collecting physiologic patient data to guide treatment plans. The main differences are the types of data collected and how. RTM codes allow for monitoring “non-physiologic data” focusing on patient data through signs, symptoms, and functions of therapeutic response (e.g. therapy adherence and response). RPM codes focus on physiologic data generally understood to be parameters generated by the body (e.g. ECG, blood pressure, etc.) that are detectable by a signal acquisition medical device/system. RTM data can be patient-reported and digitally uploaded, while RPM data can only be digitally uploaded. For both sets of codes, the device used must meet the FDA definition of a device as described in section 201(h) of the Federal Food, Drug and Cosmetic Act (FFDCA). Hero meets this definition.

RTM codes are classified as General Medicine services. Physicians and eligible, qualified healthcare professionals (including but not limited to therapists, physiatrists, nurse practitioners, and other practitioners with Medicare billing privileges) are permitted to bill using the RTM codes. 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 physical therapist or occupational therapist, by a therapy assistant under the physical therapist’s or occupational therapist’s supervision.

No, physicians cannot bill the same patient for both RTM and RPM in the same 30-day period. Providers should work with a billing expert to consider which patients in their panel would be better served by RTM or RPM.

In order to bill for RTM (i.e., 98975, 98976, 98977), a medical device must monitor at least 16 days of medication event data per 30-day period.

Code 98980 requires at least one interactive communication as part of the 20-minute billing increment between the physician or billing provider and the patient/caregiver. Code 98981 is used for each additional 20 minutes thereafter.

RTM codes may be able to be billed during the same service period as chronic care management services, transitional care management services, principle care management services and behavioral health integration services. Work with a billing advisor or other expert to help determine whether it is appropriate to bill different combinations of codes.