Remote Therapeutic Monitoring codes are similar to remote physiological monitoring codes (RPM). However, RTM primary billers are meant to be psychiatrists, nurse practitioners (NPs), and physical therapists (PTs). RTM allows for non-physiological data to be collected, which also differs from RPM.
CMS had expressed concerns that certain therapists would not be able to bill for these services. However, CMS believes the services described by the codes are important to beneficiaries and are finalizing a policy that “permits therapists and other qualified healthcare professionals to bill the RTM codes as described. However, 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.”
The Remote Therapeutic Monitoring codes are:
• 98975 – Remote therapeutic monitoring initial set up and patient education on use of equipment.
• 98976 – Remote therapeutic monitoring with device(s) supply with scheduled recording(s) and/or programmed alert(s) transmission(s) to monitor respiratory system, each 30 days.
• 98977 – Remote therapeutic monitoring with device(s) supply with scheduled recording(s) and/or programmed alert(s) transmission(s) to monitor musculoskeletal system, each 30 days).
• 98980 – Remote therapeutic monitoring code for management services physician/other qualified health professional’s time in a calendar month requiring at least one interactive communication with the patient/caregiver in a calendar month, first 20 minutes.
• 98981 – Remote therapeutic monitoring code for management services physician/other qualified health professional’s time in a calendar month requiring at least one interactive communication with the patient/caregiver in a calendar month, each additional 20 minutes.
CMS is finalizing five codes for Principal Care Management (PCM) and Chronic Care Management(CCM).
These codes are:
• 99437 – CCM service each additional 30 minutes by a physician or other qualified health care professional, per calendar month.
• 99424 – PCM services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
• 99425 – PCM services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
• 99426 – PCM for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.
• 99427 – PCM for a single high -risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
ADDITIONAL REMOTE THERAPEUTIC MONITORING CODES & POLICIES
Allow Opioid Treatment Programs (OTPs) to use audio-only to furnish therapy and counseling when live video is not available to beneficiary after the PHE is over. Modifier 95 will need to be used to claim the counseling and therapy add on code G2080.
After the PHE, OTPs will need to document audio-only was used in patient medical record along with a modifier. The latter requirement would apply to services taking place after PHE.
During the PHE, CMS allowed for certain in-person supervision requirements or the availability of the supervisor in-person to be provided virtually through telehealth. After soliciting comments, CMS has decided that it will consider addressing the concerns raised in future rules or guidance.
CMS is allowing for inclusion of 99441, 99442 and 99443 in the definition of primary care services used for beneficiary assignment until no longer payable under the physician fee schedule fee for service payment policies under the Shared Savings program for ACOs.
CMS declines to add telephone codes 99441-99443 as permanent services that will be reimbursed.
Medical nutrition therapy (MNT) and Diabetes self-management training (DSMT) services may be provided as telehealth services when registered dietitians or nutrition professionals act as distant site practitioners.
Food prescriptions are part of a broader concept of social prescribing. Pioneered in the United Kingdom and growing in popularity in the United States and Canada, social prescriptions are issued by health-care practitioners to provide patients with non-pharmaceutical interventions, including dance classes, walking groups, volunteer work, art lessons and, of course, fresh fruits and vegetables.
Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a “nutrition-based treatment provided by a registered dietitian nutritionist.” It includes “a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes.
Medication Therapy Management (MTM) Programs are required by the Centers for Medicaid and Medicare Services (CMS) for all Part D Prescription Drug Plans (PDP) and Medicare Advantage Plans (MA). This valuable program is offered free of charge and is not considered a benefit. There are no additional co-pays or charges.