Remote therapeutic monitoring: what you need to know about the changes proposed by CMS | Blogs | Health law today
On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed five new changes to remote therapy monitoring (RTM) services under the Medicare program. The changes, which are part of the proposed 2023 Medicare Physician Fee Schedule rule, were anticipated by digital health providers hoping to see more clarity and flexibility for RTM services. In this year‘s proposed rule, CMS builds on its 2022 introduction of new RTM codes (CPT codes 98975, 98976, 98977, 98980 and 98981).
The rule, if adopted as proposed, will:
- Introducing four new RTM codes, with one pair intended for use by physicians or non-physician practitioners (NPP) and the other pair intended for use by non-physician qualified healthcare professionals (PSQ);
- Allow RTM services billed as part of a physician’s or NPP’s Medicare enrollment to be provided by clinical staff under general supervision, rather than direct supervision;
- Clarify certain prerequisites for invoicing certain RTM codes;
- Postpone the creation of a general device code for the RTM; and
- Introducing a new contract-priced RTM device code for cognitive behavioral therapy.
Four new RTM codes introduced
When the RTM codes were originally created, some practitioners were unsure how the codes applied to non-physician QHPs (e.g. physiotherapists, occupational therapists, speech language pathologists, licensed clinical social workers, licensed practical nurses certified), because the codes were classified under the category “General medicine” and not under the category “E/M services”. Practitioners were uncertain whether any of the TMR could be performed by clinical staff in relation to the services of the billing practitioner and, if so, the level of supervision required by the billing practitioner.
In response, CMS proposed replacing two of the current RTM codes (CPT 98980 and 98981) with four new HCPCS G codes that specify whether RTM services are provided by a physician or NPP versus a non-physician QHP. (G codes are temporary codes assigned to services and procedures that are under review before being included in CPT codes.)
The proposed RTM codes are:
- Code HCPCS GRTM1 (Remote therapeutic monitoring treatment management services, the time of a physician or NPP professional in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes of evaluation and management services).
- HCPCS code GRTM2 (Remote therapeutic monitoring treatment management services, the time of a physician or NPP professional in a calendar month requiring at least one interactive communication with the patient/caregiver for one calendar month; each additional 20 minutes of appraisal and management services during the calendar month (list separately in Additional [sic] to be coded for the primary procedure).
- Code HCPCS GRTM3 (Remote Therapeutic Monitoring Treatment Assessment Services, First 20 minutes provided personally/directly by a non–qualified healthcare professional physician more than a calendar month requiring at least one interactive communication with the patient/caregiver During the month).
- HCPCS code GRTM4 (Remote Therapeutic Monitoring Treatment Assessment Services, 20 additional minutes provided personally/directly by a non–qualified healthcare professional physician more than a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month (list separately in addition to the code for the primary procedure)).
Based on code descriptors and CMS comments, it appears that GRTM1 and GRTM2 are reserved for physicians and NPPs, while GRTM3 and GRTM4 are reserved for non-physician QHPs.
By separating codes by practitioner type, RTM codes for physicians and NPPs can leverage more flexible billing models (eg, Medicare billing for “incident” services provided under general supervision). RTM codes for non-physician QHPs should generally be provided directly by the billing practitioner. If these new HCPCS codes are adopted, the current CPT codes 98980 and 98981 would become non-payable by Medicare (because they would be replaced by the HCPCS codes).
RTM Furnished Under General Supervision
Under the proposed rule, HCPCS codes GRTM1 and GRTM2 may be provided under general supervision, rather than under direct supervision. Direct supervision means that the physician and clinical staff must be in the same building at the same time (but not in the same room). General supervision does not require the doctor and clinical staff to be in the same building at the same time, and instead the doctor could use telemedicine technologies to exercise general supervision over clinical staff. Changing the RTM rules to expressly allow the billing of GRTM1 and GRTM2 under general supervision significantly expands the potential operations and business models associated with RTM services when used by physicians or nuclear power plants.
Clarification on RTM billing requirements
Prior to the proposed rule, CMS had not published express guidance as to whether RTM Business Codes could only be billed in combination with an accompanying RTM Device Code, or whether RTM Business Codes could be billed even if the device fails to collect at least 16 days of tracking data.
In the proposed rule, CMS stated that RTM device codes (CPT 98975, 98976, 98977) must be charged before declaring RTM business codes (GRTM1, GRTM2, GRTM3, GRTM4). Additionally, if at least 16 days of data is not reported within a 30-day period, business codes may not be billed for that period. In other words, all RTM device code requirements must be met in order to charge for RTM professional codes. If this proposed clarification is finalized, RTM professional codes could not be used to manage the treatment of a condition where codes other than CPT codes 98985 and 98976/98977 were used to collect the data or if monitoring did not include at least 16 days of data.
The CMS has also stated that the Physician/NPP RTM Professional Codes (GRTM1, GRTM2) cannot be billed in conjunction with the Unqualified Healthcare Professional Codes (GRTM3, GRTM4). For example, a doctor could not bill RTM with a physiotherapist also billing RTM for the same patient.
No generic device code
Current RTM device power codes (CPT 98976, 98977) are limited to transmissions for monitoring the respiratory or musculoskeletal systems. These codes do not target other systems (e.g., neurological, vascular, endocrine, digestive, etc.), which has limited use cases for RTM.
In the proposed rule, CMS has acknowledged requests to develop generic device code for RTM to broadly apply to all conditions/systems. CMS declined to create such code, saying it will wait and instead seek feedback to inform any new device-related coding. Accordingly, CMS is requesting information and feedback on the types of data collected using RTM devices, how data is collected to address specific health issues and what those health issues are, the associated costs to the RTM devices available to collect RTM data, how long the typical episode of care per condition type might last, and the potential number of beneficiaries for whom an RTM device might be used per health condition type. These comments can be submitted now by interested stakeholders.
New Cognitive Behavioral Therapy Monitoring Device Code at Contract Price
In 2021, the American Medical Association (AMA) CPT Editorial Board created a new CPT code 989X6 to code Cognitive Behavioral Therapy (CBT) monitoring services. The proposed new code reads as follows:
Remote therapeutic monitoring (eg, adherence to treatment, response to treatment); provision of device(s) with scheduled recording(s) (e.g. daily) and/or transmission of scheduled alert(s) to monitor cognitive behavioral therapy, every 30 days).
Based on the WADA recommendation, CMS is proposing to set the Contractor Price for Device Code CBT for 2023. Contractor Price Status means that the new value of Device Code CBT and payment would be set at the discretion of each local Medicare Administrative Contractor (MAC) and may vary nationally. Practitioners should refer to their local MACs for specific coverage and billing guidelines for the new CBT device code. CMS cited the lack of currently available information on devices usable with this code as justification for its decision to set the contractor’s price for the CBT device code.
What to do next?
Providers, health technology companies and virtual care entrepreneurs interested in RTM may consider providing comments on the proposed rule. CMS invites comments on the proposed rule until 5:00 p.m. ET on September 6, 2022. Anyone can submit comments – anonymously or otherwise – by electronic submission at this link. Alternatively, commenters may submit their comments by mail to:
- Ordinary mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, PO Box 8016, Baltimore, MD 21244-8016.
- Express Night Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1770-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850
If submitting by mail, be sure to allow sufficient time for comments to be received before the closing date.
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