Setting up Remote Therapeutic Monitoring (RTM) in your organization is a great idea, as it facilitates better, more personalized care provision. However, it is important to know the correct CPT (Current Procedural Terminology) codes assigned to each service or procedure you provide in order to receive the correct reimbursement.  

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The four CPT codes you need to know, when working with musculoskeletal conditions, are 98975, 98977, 98980 and 98981. These are ‘service codes,’ which encompass: providing a necessary medical device to a patient (i.e., the moveUp patient app, to help collect physiological or therapeutic data); providing assistance with setting up the device; educating on RTM, data collection, and best practices; and data collection and transmission.

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Note: For the most part, RTM is billed under Medicare, although other insurance providers have begun to also include it in their billing structure, so it is worthwhile checking with any relevant providers about this.

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What do the codes mean and how much can you reimburse?

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98975

For the initial set up of RTM and educating the patient on how to use the equipment. You can bill for this once per episode of care, for an average of $19, once the RTM service starts. This ends when treatment goals are met. However, you cannot bill for this code if you monitor for less than 16 days.

98977

This code is for the supply of devices for monitoring the musculoskeletal system (allowing for scheduled recordings and/or programmed alerts). This can be billed once every 30 days. If a patient continues to use RTM services, you can continue to bill every 30 days with an average reimbursement of $50. However, if monitoring occurred for less than 16 days out of 30, you cannot bill or the code.

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98980

This code refers to monitoring and treatment management services with a health care professional in a calendar month and can be billed for the first 20 minutes of care provided to the patient but requires interactive communication. This means phone or video calls and the discussion may revolve around their programme, pain levels, reviewing exercise compliance and more. If you do this, you may reimburse around $50, as long as you do not go below 20 minutes.

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98981

If you have billed for code 98980, you can use this code to bill for each additional 20 minutes of interactive communication with the patient/caregiver as part of the RTM monitoring/treatment management services for an average of $40, multiple times per month. So, you may take more time answering questions or reviewing data, for example.  

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Note: In the 2024 CMS Final Rule, RTM changes included changes to the 16/30 rule. This means treatment under codes 98980 and 98981 does not need to adhere to the current 16-day data requirement, meaning you should record at least 16 days of data in any 30-day period, allowing for greater flexibility.

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Who can bill under the CPT codes?

The CMS has stated that these codes can be billed by “physicians and other eligible healthcare professionals”, therefore including physical and occupational therapists, provided you practice within state and organization rules.  

Hopefully, this blog has shed light on the relevant billing codes for you and your colleagues. If you are considering implementing RTM services in your practice, why not reach out to us and see if the moveUP app is right for you?