We at WebPT are big proponents of the potential benefits of remote therapeutic monitoring (RTM): it’s a great way to improve patient engagement as well as outcomes, and it helps rehab therapists collect better data to make the case for better reimbursements from payers. But those are big, lofty ideals, and most clinicians are thinking about how they apply to the nitty-gritty of implementing RTM—namely, how to use and document it with their patients. In fact, that was one of the most common questions we received during our February webinar on RTM. So, we’ve put together an example for those who haven’t yet adopted RTM of how it would work with a typical patient, and what you might want to include in your SOAP notes to document defensibly.
What are the RTM codes?
But first, a refresher (or maybe crash course?) on the current RTM CPT codes, descriptions, and billing frequencies, as we’ll be using them in the coding example below:
How would I set patients up with RTM?
Let’s say you have an initial eval with a patient on April 1 and determine they have knee osteoarthritis (OA), and that they seem motivated to tackle the work involved in treatment. During this first session, you provide the patient with the RTM app or device, prescribe a digital HEP that would be reported through RTM, and then show them how they would input and submit their data for your review. You would also answer any questions or concerns the patients would have about RTM. All of this would fall under RTM CPT code 98975, which is billed once per episode of care and covers set-up and patient education, and CPT code 98977, which covers the supply of the device and can be billed every 30 days—provided that the RTM device or software has at least 16 days of data for the 30-day period.
It can also be billed at any time during that episode of care, so if you determine a patient is a fit for RTM after subsequent visits, you haven’t missed your window.
There’s also flexibility as to when you can bill for 98975. Depending upon how your billing software and workflows are structured, you can bill 98975 on the day of set-up and education, or you can choose to wait to bill it with 98977 after 30 days of RTM use (assuming that 16 days of monitoring have occurred in that period). Some folks opt for the latter option in an effort to streamline their claims submissions.
In your documentation, you would note that the patient was an appropriate candidate for RTM due to whichever factors you feel are relevant: both the aforementioned ease of monitoring and motivation could be included, as well as a patient’s age, risk factors, or mobility or travel concerns. You can also note the date of setup if you’re billing for it at a later date.
When do you monitor treatment—and how do you document and bill for it?
After you’ve set a patient up with RTM, you need to see how they’re progressing in their prescribed exercises. In this example, you want to check in on the patient at the midway point between their weekly appointments. Let’s say that you’re planning to see the patient once a week for eight weeks while using RTM to supplement their treatment between visits. With the patient coming in for their second visit on April 8, you log into the app on April 4 and spend 13 minutes reviewing their data. For this interaction, you wouldn’t be able to bill for any additional codes yet. RTM CPT code 98980—which covers the first 20 minutes of monitoring for a given 30-day period—requires you to meet the full 20 minutes of monitoring before you can bill for it, so you’ll need to meet that threshold with subsequent monitoring interactions.
Billing for 98980 also requires at least one synchronous communication with the patient within that 30-day period, which means a phone call, FaceTime, or other live communication—time which counts towards that 20-minute threshold. Assuming you follow up with a phone call checking in on the patient’s initial progress, and are on the phone for more than five minutes, you’ve met the 20 minutes needed for code 98980, which can be billed once per month.
Can I bill for subsequent monitoring?
After the patient’s April 8 visit, you check back in on their RTM data on April 12 for an additional 14 minutes. You also use this opportunity to FaceTime with your patient for eight minutes to see how they’re getting on with their home exercise program (HEP) thus far. You would now have one unit of 98981, which you would list separately in a calendar month each additional 20 minutes of monitoring after the initial 20 minutes covered under 98980.
Monitoring the patient for the rest of the month at that cadence, you would check in on April 19 and April 26 for roughly 10-15 minutes at a time. Assuming interactive communications that put you over 20 minutes on both occasions, you would bill for two more instances of code 98981.
To document for 98980 and 98981, you need to note the date of monitoring and the time spent on monitoring, as well as any alterations or interventions you’re making as a result of what you’re seeing in a patient’s data. The goal of your documentation should be to justify the continued use of RTM.
The bill(ing) comes due.
We’re now at April 30, which means it’s time to figure out what you need to bill for with this particular patient. Because CPT codes 98980 and 98981 are billed every calendar month, you can bill for one unit of each in this particular scenario. You can also bill 98975 for the initial set-up and education assuming you have 16 days of data collection, although as noted earlier, it can be billed at any point in an episode of care. For the sake of simplicity in this example, you choose to bill it with the other RTM codes.
Billing for code 98977 can be a bit more complicated. Like 98975, code 98977 requires 16 days of monitoring over a 30-day period, but because it’s billed every 30 days as opposed to every calendar month (or per episode of care). Because of that, your billing for 98977 could be out of sync with the rest of your RTM codes if a patient begins RTM in the middle of the month. It also requires daily data transmission for the entire monitoring period, although you don’t need to review that data on a daily basis.
However, for the purposes of this exercise, we’ve kept it simple and had the patient begin RTM on April 1, so you can add 98977 in with the rest of the codes billed for this month. So for April, you’d be billing one unit each of CPT codes 98975, 98977 and 98980, and three units of CPT code 98981.
If you continue the patient with RTM into May, you would be able to bill for one unit of code 98977 on May 30, and any instances of 98980 and 98981 on May 31. You are not able to continue with RTM after a patient has completed their plan of care, to answer a question that has popped up a handful of times both during and after our RTM webinar.
What else do I need to know?
Two other frequently asked questions we received during our recent RTM webinar were regarding which types of patients to use RTM with, and how often to monitor those patients. Unfortunately, there’s no prescriptive answer to either. The codes as written reference musculoskeletal (MSK) and respiratory impairments, and you could make a case for any diagnosis to have these impairments—so long as you’re thoroughly documenting those deficits. If you’re looking for more obvious candidates, patients with easier-to-monitor impairments or who might struggle to make frequent trips to the clinic for mobility issues would fit well into an RTM program. And patients who are making fewer visits make sense for RTM—although some high-frequency patients may want and need more touchpoints beyond their regular sessions.
By way of offering some additional examples to illustrate the point, WebPT VP of Outcomes and Clinical Transformation Susan Lofton, MPT, highlighted during the webinar that the mean age of the average RTM patient, as found in WebPT’s data, is 57 years old, with the mode at 71 years of age. She also broke down the ICD-10 codes most commonly used in conjunction with RTM:
Another consideration is how you want to dedicate your personnel and their time to RTM. Some clinics choose to set aside dedicated time for RTM for some or all of their providers, while others take a “catch as catch can” approach and have their clinicians monitor patients when they can fit it into their schedule. Others devote PTAs and OTAs to monitoring which, while requiring a CO or CQ modifier, can still be effective and profitable even with the 15% payment reduction. Just keep in mind supervision requirements differ in private practices and a state-by-state basis.
Finally, there’s the potential difference between payers to consider. Not every insurance company is going to cover RTM, so you should check a patient’s benefits beforehand. And some insurers that do cover RTM consider RTM notes as a visit towards a patient’s limit—something else you want to know before you begin monitoring with a patient.
Obviously, every patient is different, so each instance of RTM will vary as such in its frequency and duration. But hopefully you’ve gained a better grasp on how RTM fits into your current work with treatment—and how it can help improve outcomes and your bottom line.