What’s the Difference Between Remote Patient Monitoring and Remote Therapeutic Monitoring?

Given the apparent similarities, clinicians can be forgiven for wondering what the difference is between remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). While they may seem interchangeable at first glance, RTM differs enough from RPM to warrant separate CPT codes as well as a brief explainer for physical therapists and occupational therapists considering introducing remote care modalities to their patients. 

What is RPM?

Remote patient monitoring allows physicians and other qualified healthcare professionals to track patient health outside of the office using devices that transmit physiologic data (e.g., heart rate, blood pressure, body temperature) back to the caregiver. The devices used and data collected can vary depending upon the patient and condition, but the benefit in any instance is a fuller picture of a patient’s wellbeing, as well as an easier way for providers to monitor patients with chronic conditions or those requiring post-discharge care.  

According to HHS, RPM helps

• Reduce hospitalizations; 
• Reduce time spent in hospital;
• Produce better outcomes for rural patients; and
• Better manage chronic conditions.

RPM allows physicians to provide treatment that is better and ultimately more cost-effective for payers—exactly what PTs and OTs believe RTM can provide for their patients. 

What is RTM, and how is it different?

This is a common question following the publication of the 2022 final rule, and fortunately it’s one we’ve spent some time covering; you can check out our answers to RTM FAQs or read up on the benefits of RTM if you’d like.

The COVID-19 pandemic made RPM essential for healthcare providers, and after seeing how effective it proved in treatment, PTs and OTs pushed for similar codes to use and bill. Enter RTM. And while RPM served as a template for what CMS introduced with its RTM codes, there are some important differences that determine who can bill for them—and how. 

RPM and RTM collect different types of data. 

Given that existing RPM codes didn’t fit the needs of PTs and OTs, RTM codes were created with an eye towards addressing those specific monitoring requirements. While RPM and RTM both require the use of monitoring tools that meet the FDA definition of a medical device, the information collected and transmitted by RTM devices is non-physiologic data that’s limited to musculoskeletal system status or respiratory system status. Crucially for PTs and OTs, the non-physiologic data covered by RTM codes includes medication adherence and medication response as well as therapy adherence and therapy response. 

Unlike RPM’s requirement that patient data be collected and transmitted automatically, the data for RTM can be self-reported by the patient. And while it might seem that automatically collected data would be more reliably gathered, self-reported data allows providers to collect that essential information on adherence, response and pain levels that can’t otherwise be tracked by devices used in RPM.  

RTM has separate billing and reimbursement guidelines from RPM. 

One of the issues PTs and OTs faced with RPM, apart from their need for different types of data, was that the RPM codes are Evaluation and Management (E/M) codes, and thus unavailable to PTs and OTs. By introducing RTM codes as general medicine codes, CMS has enabled more caregivers to make use of them in treatment and billing—specifically, PTs and OTs.    

The new RTM codes are a bit more stringent in how they can be used in billing, however. With RPM, services administered by clinical staff can be billed as “incident to” services provided by a physician or qualified healthcare provider. RTM, on the other hand, doesn’t permit for staff to perform those functions under general supervision; as the 2022 final rule notes, “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 that may not be an insurmountable challenge for most PTs and OTs, it’s worth bearing in mind as clinics consider how to deploy staff.   

One positive note is that the 989X4 and 989X5 monitoring codes are paid at the same rate as the corresponding RPM codes, 99457 and 99458. That payment parity further demonstrates the value CMS places on RTM, and helps the bottom line of PTs and OTs.   

While there will undoubtedly be changes made to RTM codes in the near future to further meet the needs of stakeholders and practitioners, it’s a significant step for rehab therapists—and champions of telehealth and digital health alike—that CMS saw the need for RTM services and RTM codes and chose to implement changes. Hopefully, PTs and OTs recognize that significance as well and make use of RTM to achieve better patient care and outcomes.