On July 7, 2022, the Facilities for Medicare & Medicaid Companies (CMS) proposed 5 new adjustments to Distant Therapeutic Monitoring (RTM) companies underneath the Medicare program. The adjustments, a part of the proposed 2023 Medicare Doctor Price Schedule rule, have been anticipated by digital well being suppliers hoping to see extra readability and adaptability for RTM companies. On this 12 months’s proposed rule, CMS constructed upon its 2022 introduction of new RTM codes (CPT Codes 98975, 98976, 98977, 98980, and 98981).
The rule, if enacted as proposed, will:
- Introduce 4 new RTM codes, with one pair supposed to be used by physicians or non-physician practitioners (NPPs) and the opposite pair supposed to be used by non-physician certified well being care professionals (QHPs);
- Enable RTM companies billed underneath a doctor or NPP’s Medicare enrollment to be furnished by medical workers underneath basic supervision, reasonably than direct supervision;
- Make clear sure conditions for billing sure RTM codes;
- Postpone the creation of a basic machine code for RTM; and
- Introduce a brand new contract-priced RTM machine code for cognitive behavioral remedy.
4 New RTM Codes Launched
When the RTM codes have been initially created, some practitioners have been confused how the codes utilized to non-physician QHPs (e.g., bodily therapists, occupational therapists, speech language pathologists, licensed medical social employees, licensed registered nurse assistants), because the codes have been categorised underneath the “Common Medication” class, not the “E/M Companies” class. Practitioners have been unsure if any portion of RTM might be carried out by medical workers incident to the companies of the billing practitioner and, in that case, the extent of supervision required by the billing practitioner.
In response, CMS proposed to switch two of the present RTM codes (CPTs 98980 and 98981) with 4 new HCPCS G codes that specify if the RTM companies are delivered by a doctor or NPP versus a non-physician QHP. (G codes are non permanent codes assigned to companies and procedures which are underneath evaluate previous to being included within the CPT codes.)
The proposed RTM codes are:
- HCPCS code GRTM1 (Distant therapeutic monitoring remedy administration companies, doctor or NPP skilled time over a calendar month requiring not less than one interactive communication with the affected person/caregiver in the course of the calendar month; first 20 minutes of analysis and administration companies).
- HCPCS code GRTM2 (Distant therapeutic monitoring remedy administration companies, doctor or NPP skilled time over a calendar month requiring not less than one interactive communication with the affected person/caregiver over a calendar month; every further 20 minutes of analysis and administration companies in the course of the calendar month (Record individually in further [sic] to code for major process).
- HCPCS code GRTM3 (Distant therapeutic monitoring remedy evaluation companies, first 20 minutes furnished personally/immediately by a non–doctor certified well being care skilled over a calendar month requiring not less than one interactive communication with the affected person/caregiver in the course of the month).
- HCPCS code GRTM4 (Distant therapeutic monitoring remedy evaluation companies, further 20 minutes furnished personally/immediately by a non–doctor certified well being care skilled over a calendar month requiring not less than one interactive communication with the affected person/caregiver in the course of the calendar month (Record individually along with code for major process)).
Primarily based on the code descriptors and CMS commentary, it seems GRTM1 and GRTM2 are reserved for physicians and NPPs whereas GRTM3 and GRTM4 are for non-physician QHPs.
By separating codes by practitioner sort, the RTM codes for physicians and NPPs can harness extra versatile billing fashions (e.g., billing Medicare for “incident to” companies supplied underneath basic supervision). The RTM codes for non-physician QHPs typically have to be furnished immediately by the billing practitioner. If these new HCPCS codes are adopted, the present codes CPTs 98980 and 98981 would turn out to be non-payable by Medicare (as a result of they might get replaced by the HCPCS codes).
RTM Furnished Below Common Supervision
Below the proposed rule, HCPCS code GRTM1 and GRTM2 could also be furnished underneath basic supervision, reasonably than direct supervision. Direct supervision means the doctor and medical workers have to be in the identical constructing on the similar time (albeit not the identical room). Common supervision doesn’t require the doctor and medical workers to be in the identical constructing on the similar time, and the doctor might as an alternative use telemedicine applied sciences to exert basic supervision over the medical workers. Altering the RTM guidelines to expressly permit incident to billing of GRTM1 and GRTM2 underneath basic supervision tremendously expands the potential operations and enterprise fashions related to RTM companies when utilized by physicians or NPPs.
Clarification on RTM Billing Necessities
Previous to the proposed rule, CMS had not printed categorical steerage on whether or not the RTM skilled codes might solely be billed together with an accompanying RTM machine code, or if the RTM skilled codes might be billed even when the machine fails to gather not less than 16 days of knowledge monitoring.
Within the proposed rule, CMS acknowledged the RTM machine codes (CPTs 98975, 98976, 98977) have to be billed previous to reporting the RTM skilled codes (GRTM1, GRTM2, GRTM3, GRTM4). Furthermore, if not less than 16 days of knowledge usually are not reported throughout a 30 day interval, the skilled codes is probably not billed for that interval. In different phrases, all necessities of the RTM machine codes have to be met so as to invoice the RTM skilled codes. If this proposed clarification is finalized, the RTM skilled codes couldn’t be used to handle the remedy of a situation the place codes aside from CPT codes 98985 and 98976/98977 have been used to gather the info or if the monitoring companies didn’t embrace not less than 16 days of knowledge.
CMS additionally acknowledged the doctor/NPP RTM skilled codes (GRTM1, GRTM2) can’t be billed along side the non-physician certified well being care skilled codes (GRTM3, GRTM4). For instance, a doctor couldn’t invoice RTM with a bodily therapist additionally billing RTM for a similar affected person.
No Generic Gadget Code
The present RTM machine provide codes (CPTs 98976, 98977) are restricted to transmissions for monitoring the respiratory or the musculoskeletal techniques. These codes don’t goal different techniques (e.g., neurological, vascular, endocrine, digestive, and so forth.), which has restricted the use instances for RTM.
Within the proposed rule, CMS acknowledged receipt of requests to develop a generic machine code for RTM to broadly apply to all situations/techniques. CMS declined to create such a code, stating it should wait and as an alternative search feedback to tell any new coding regarding gadgets. Accordingly, CMS requests data and feedback associated to the varieties of information collected utilizing RTM gadgets, how the info which are collected to unravel particular well being situations and what these well being situations are, the prices related to RTM gadgets which are obtainable to gather RTM information, how lengthy the everyday episode of care by situation sort would possibly final, and the potential variety of beneficiaries for whom an RTM machine is likely to be utilized by the well being situation sort. Such feedback may be submitted now by stakeholders.
New Contract-Priced Cognitive Behavioral Remedy Monitoring Gadget Code
In 2021, the American Medical Affiliation’s (AMA) CPT Editorial Panel created a brand new CPT code 989X6 to code for Cognitive Behavioral Remedy (CBT) monitoring companies. The proposed new code reads as follows:
Distant therapeutic monitoring (e.g., remedy adherence, remedy response); machine(s) provide with scheduled (e.g., each day) recording(s) and/or programmed alert(s) transmission to watch cognitive behavioral remedy, every 30 days).
Primarily based on the AMA’s advice, CMS proposes to contractor worth the CBT machine code for 2023. Contractor priced standing means the brand new CBT machine code worth and fee can be established on the discretion of every native Medicare Administrative Contractor (MAC) and will range nationally. Practitioners might want to check with their native MACs for particular protection and billing pointers of the brand new CBT machine code. CMS cited a dearth of knowledge presently obtainable about gadgets useable with this code because the rationale for its resolution to contractor worth the CBT machine code.
What to Do Subsequent?
Suppliers, well being expertise firms, and digital care entrepreneurs focused on RTM can take into account offering feedback to the proposed rule. CMS is soliciting feedback on the proposed rule till 5:00 p.m. ET on September 6, 2022. Anybody might submit feedback – anonymously or in any other case – through digital submission at this hyperlink. Alternatively, commenters might submit feedback by mail to:
- Common Mail: Facilities for Medicare & Medicaid Companies, Division of Well being and Human Companies, Consideration: CMS-1770-P, P.O. Field 8016, Baltimore, MD 21244-8016.
- Categorical In a single day Mail: Facilities for Medicare & Medicaid Companies, Division of Well being and Human Companies, Consideration: CMS-1770-P, Mail Cease C4-26-05, 7500 Safety Boulevard, Baltimore, MD 21244-1850
If submitting through mail, make sure you permit time for feedback to be acquired earlier than the cut-off date.
Wish to Be taught Extra?
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