By Natalie Zukoff, Vaica
The Center for Medicare & Medicaid Services (CMS) has included a new category of Current Procedural Terminology (CPT) codes in the 2022 Physician Fee Schedule in order to address “remote therapeutic monitoring.” CPT codes are medical codes which are used to report medical, surgical, and diagnostic procedures and services to entities including health insurance companies and physicians. CMS has been expanding coverage for remote patient monitoring since it first recognized the platform in 2019. Up until this year (2022) CPT codes related to remote patient monitoring were focused on coverage of remote physiological data such as heart rate and blood pressure.
So what has changed and why? The CMS 2022 Physician Fee Schedule includes remote therapeutic monitoring codes, suggesting that the COVID-19 response in digital health policy has left its mark. These therapeutic monitoring codes can be used for medication adherence monitoring as well, which was not a big focus point in prior-COVID codes. The new CMS CPT codes represent a major step in the right direction, as preventable hospitalizations and ER visits in the U.S. related to non-adherence cost up to $300 billion a year.
The new schedule includes five new RTM codes, which went live on January 01, 2022. The new codes are:
- CPT #98975: Remote therapeutic monitoring initial set-up and patient education and use of equipment
- CPT #98976: Remote therapeutic monitoring devices supply with scheduled recordings and/or programmed alerts transmission to monitor respiratory system, each 30 days
- CPT #98977: Remote therapeutic monitoring devices supply with scheduled recordings and/or programmed alerts transmission to monitor musculoskeletal system, each 30 days
- CPT #98980: Remote therapeutic monitoring treatment physician/other qualified health professional time in a calendar month requiring at least one interactive communication with patient/caregiver during calendar month; first 20 minutes
- CPT #98981: Remote therapeutic monitoring treatment physician/other qualified health professional time in a calendar month requiring at least one interactive communication with patient/caregiver during calendar month; each additional 20 minutes
Although CMS has increased reimbursement opportunities in recent years for patients that are being monitored remotely, the newer categories of reimbursement for digital health are much more clear. The main difference is that RPM codes can only be used in conjunction with tracking physiological data, however under the new codes, therapeutic data (data around indicators of therapy/medication adherence and response and pain level) can be assessed remotely as well.
The Schedule reflects a move towards a much more permanent and well needed expansion of reimbursable telehealth services. As we continue to face COVID-19’s ongoing challenges, and without knowing what may come down the road, we need to be well-prepared. Part of this preparation is recognizing the value of RPM & RTM services and getting familiarized with the current available options to ensure the entire care delivery system is functioning at its highest ability.