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The annual cost of all conditions to the healthcare system is staggering, specifically the costs associated with MSK conditions. On average, musculoskeletal conditions cost the healthcare system ~$600 billion dollars per year. That’s more than twice what heart disease costs the healthcare system.
Research shows that early and adherent physical therapy can not only decrease these costs, but also improve patient outcomes. Prescribing home exercise programs is a gold standard for almost all physical therapy clinics, however, only about 30% of patients are actually successful with completing their home exercise programs.
Additionally, as much as 80% of information told to patients in the clinic is immediately forgotten, including the importance of, and the nuances related to a patient’s home exercise program. RTM is intended to be a solution to bridge the gap between those in-clinic visits.
Remote therapeutic monitoring (RTM) refers to the use of technology to track and remotely monitor a patient's health status, treatment progress, and adherence to a provider’s plan of care, specifically for musculoskeletal and respiratory patients. The Centers for Medicare and Medicaid Services (CMS) approved the RTM CPT® codes for coverage and payment in the 2022 Physician Fee Schedule.
We have seen how useful digital technology can be for both patients and providers. From the evolution of EMRs for providers to the use of step trackers for patients, the healthcare industry continues to offer providers and their patients with more opportunities to be informed.
Introduced in January 2022, Remote Therapeutic Monitoring (RTM) represents the next stage in integrating digital technology into healthcare. It offers a seamless opportunity for providers and patients to engage with treatment plans and home exercise programs by providing remote tools, virtual support, and communication between in-clinic appointments. Research indicates that communication outside of clinic visits can enhance exercise adherence and the amount of exercise performed, thanks to improved social support and feedback.
Continuous communication between the patient and the care team provides valuable insights for modifying the care plan effectively. By combining subjective and objective measures, RTM paints a clear picture of the patient's status and response to treatment. Adjustments made to the plan based on RTM data can enhance patient adherence to home exercise programs and improve outcomes significantly.
According to the rules published by CMS, RTM refers to the collection and monitoring of ‘non-physiological data’ via an approved ‘medical device’.
Non-physiological data includes musculoskeletal system status, therapy adherence, and therapy response (think pain scores, exercise compliance data, and outcome measures).
Dissimilar to Remote Physiologic Monitoring or RPM (where patient data must be automatically transmitted to the provider via a connected medical device), with RTM, the data can include self-reported information through the device by the patient.
The medical device must meet the definition of a medical device, as defined by the United States Food and Drug Administration (FDA) :
According to CMS, "physicians and other eligible qualified healthcare professionals" can bill for the RTM CPT codes. RTM services are within the scope of practice of several disciplines, including the following:
In all cases, providers must practice with applicable state and scope of practice laws.
During the COVID-19 Pandemic, the Remote Physiologic Monitoring (RPM) codes proved to be invaluable for physicians, enabling them to stay informed of their patient’s health status despite home quarantine measures and decreased in-person care. The only problem? Musculoskeletal and respiratory providers and services did not qualify for these codes.
RPM services are only for physicians and certain non-physician practitioners (e.g. physician assistants, nurse practitioners) and are intended to monitor a patient’s physiologic parameters such as weight, blood pressure, pulse oximetry or respiratory flow rate. RPM is typically used to monitor chronic conditions such as hypertension, diabetes, and heart disease.
RTM was created to focus on musculoskeletal and respiratory systems, therapy adherence and therapy response, and represents the review and monitoring of data related to signs, symptoms and functions of a therapeutic response. Importantly, RTM expands the types of providers allowed to bill these codes to include physical therapists and occupational therapists.
A CPT® code (or Current Procedural Terminology code) is a numerical code assigned to each medical procedure and service. These codes are used by healthcare providers to describe the services they provide to patients for billing and insurance purposes.
There are six CPT codes for RTM, only four of which are relevant to musculoskeletal conditions(the fifth being specific to respiratory system conditions and the sixth relating to cognitive behavioral therapy). For that reason, we’ll provide a detailed overview of the four applicable codes. Furthermore, the codes are broken down into two basic types: service codes and treatment management codes.
Below are some examples and key differences between the two.
Remote therapeutic monitoring; initial set-up and patient education on use of equipment. This code may be billed for a patient once per episode of care. By definition, an episode of care begins when the RTM service starts, and ends when established treatment goals are met. You can not bill code 98975 if less than 16 days of monitoring occurred.
Remote therapeutic monitoring; device(s) supply with scheduled recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days. This code can be billed for a patient once each 30 days. In other words, if the patient continues to be actively involved in the RTM service, and you continue to provide the ‘medical device’, you may continue to bill this code in subsequent 30 day periods. You can not bill code 98977 if less than 16 days of monitoring occurred during the 30-day period.
Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes. This code can be billed once per calendar month for the first 20 minutes of care provided to the patient. For instance, if you perform a total of 20 minutes during the month speaking directly with the patient regarding their therapy program, monitoring their pain level data, and reviewing their exercise compliance, you qualify to bill this code. However, if you perform only 19 minutes of these services, you do not qualify.
Remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes. This code can be billed if you perform additional services as outlined in code 98980 beyond the initial 20 minutes, during the same calendar month. For instance, if you perform an additional 22 minutes answering the patient’s questions, and reviewing and analyzing data, you qualify to bill this code. However, if you only perform an additional 15 minutes of the services, you do not qualify
*Please note, providers are only eligible to bill codes 98980 and 98981 if at least one ‘interactive communication’ with the patient is performed during the calendar month. According to CMS, ‘interactive communication’ refers to “at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.” In other words, a phone or video call. This interactive communication, must occur with the patient/caregiver within the first 20 minutes each month.
At the inception of RTM in 2022, the Remote Therapeutic Monitoring CPT codes were recognized solely by traditional Medicare and many Medicare Advantage plans. However, over time, there has been adoption from many commercial payors. With our experience, we have identified several additional payors covering RTM codes. To learn more about these payors, and better understand the ROI for your organization, click here to speak to a member of our team.
The creation and approval of the RTM codes by CMS is a significant value add for providers, patients, and payors. There are many benefits of implementing the service into your normal practice. Below are just a few key examples.
RTM enables providers to improve their clinical insight and understanding of a patient’s health status beyond in-clinic appointments. By improving visibility to health related outcomes (such as pain scores, outcome measures, and therapy adherence), providers can identify issues, intervene, and alter the patient’s care plan accordingly.
RTM removes barriers to care by meeting patients where they are, when they need it. The service allows patients to receive care from the comfort of their own homes, which can be especially beneficial for those who have access issues (such as rural areas), and difficulty attending regularly scheduled in-clinic appointments. When questions arise between visits regarding symptoms or nuances of a prescribed exercise program, patients now have the means to receive quick answers and remote support.
The RTM service is an effective patient engagement strategy, providing patients with convenient toolsets to improve their understanding of their health condition. RTM empowers patients by giving them improved access to their health data and care plan, thereby encouraging them to take a more active role in managing their condition. As motivation waivers, the remote support of RTM improves engagement. When a patient understands their condition, their unique care plan, and feel supported along the way, they’re more likely to experience positive health outcomes.
RTM enables more opportunities for communication, thereby strengthening the patient-provider relationship. Research shows that there are several reported barriers to home exercise adherence, including time constraints, pain and level of physical activity, as well as lack of social support and self-efficacy. Frequent communication and motivation, outside of regularly scheduled clinic visits, can positively impact a patient’s perception of those barriers. It provides patients with knowledge that their provider is tracking their progress and is invested in their outcomes, thereby building a lasting rapport.
With the use of the RTM CPT® codes, the RTM service line provides further opportunities for revenue compared to the traditional clinical model. Not only are these remote services reimbursable, but they also improve clinical workflow efficiencies, enhance staff productivity, and reduce administrative costs associated with in-clinic care.
RTM has the potential to decrease downstream healthcare costs by improving the ability to track existing health issues, detect new conditions before they become problematic, and triage patients appropriately. By enabling the provider to have improved visibility to patient data, and the patient to have improved access to support and care, RTM allows for early intervention, which in turn, can reduce unnecessary surgeries, MRIs, opioids, emergency room visits, and hospitalizations.
Selecting the right RTM solution for your practice is an important decision that can significantly impact patient care and outcomes. Here are a few essential factors to consider when selecting the ideal RTM technology and service for your practice, providers and patients.
Choosing the appropriate Remote Therapeutic Monitoring technology depends on discovering a platform that offers tailored and flexible solutions to match your organization's requirements. Whether you're a small clinic with five providers or a large healthcare system with thousands, the technology should seamlessly adjust to support your needs and, consequently, those of your patients.
A streamlined workflow is vital for healthcare professionals and patients to effectively utilize the remote monitoring platform. The selected RTM service should prioritize an intuitive user experience, allowing providers to effortlessly access real-time data and efficiently monitor patient progress, thereby ensuring seamless clinical care delivery.
Patient privacy and data security are paramount in the digital healthcare landscape. It's imperative the chosen RTM service and system you choose must adhere to rigorous privacy protocols and comply with industry standards, like HIPAA (Health Insurance Portability and Accountability Act). Prioritizing security ensures peace of mind for both patients and providers throughout their experience using the platform.
To optimize the advantages of RTM, it's essential to achieve seamless integration and collaboration with other healthcare providers. A well-integrated system streamlines workflows, improves care coordination, and promotes efficient communication between patients and healthcare teams, ultimately resulting in enhanced patient outcomes.
At Limber Health, we pride ourselves on offering a premier RTM platform, delivering a white-glove turnkey solution that seamlessly integrates into your practice workflow and facilitates hybrid care. By leveraging Limber's digital platform, your organization can harness the power of remote therapeutic monitoring to provide personalized care, enhance patient-provider communication, and ultimately elevate patient outcomes. We invite you to contact us today to learn more about our comprehensive solutions, designed to empower providers and that are tailored to meet your organization's needs.
