CPT Code 98975: Remote Therapeutic Monitoring (RTM)

Introduction

With the rise of digital healthcare and remote patient monitoring, CPT Code 98975 is essential for tracking and managing patient health remotely. This code covers the initial setup, patient education, and onboarding for remote therapeutic monitoring (RTM) devices, which collect data on musculoskeletal function, respiratory status, therapy adherence, and response to treatment.

Remote therapeutic monitoring (RTM) is widely used by physical therapists (PTs), occupational therapists (OTs), respiratory therapists (RTs), and other qualified healthcare professionals to enhance patient engagement, treatment outcomes, and chronic disease management.

What is CPT Code 98975?

Definition and Purpose

• CPT 98975 refers to the initial setup and patient education on the use of remote therapeutic monitoring (RTM) devices.
• It involves device configuration, patient instructions, and guidance on data collection.
• RTM is used to track therapeutic adherence, response to treatment, and functional status over time.

Importance of CPT 98975 in Medical Billing and Coding

• Ensures reimbursement for digital health services that support chronic disease management and rehabilitation programs.
• Expands remote patient care, reducing the need for frequent in-person visits.
• Helps healthcare professionals monitor patient adherence to therapy plans and make data-driven treatment adjustments.

Common Medical Conditions Managed with CPT Code 98975

1. Musculoskeletal & Rehabilitation Conditions

• Post-surgical recovery (e.g., ACL reconstruction, joint replacement)
• Chronic back and neck pain (ICD-10: M54.5)
• Arthritis and joint disorders (ICD-10: M19.90)

2. Respiratory & Pulmonary Conditions

• Asthma (ICD-10: J45.909)
• Chronic Obstructive Pulmonary Disease (COPD) (ICD-10: J44.9)
• Sleep apnea (ICD-10: G47.33)

3. Neurological & Chronic Conditions

• Parkinson’s disease (ICD-10: G20)
• Stroke rehabilitation (ICD-10: I69.30)
• Multiple sclerosis (ICD-10: G35)

4. Post-Surgical & Pain Management

• Orthopedic post-surgery recovery
• Chronic pain management (ICD-10: G89.4)
• Physical therapy adherence tracking

Who Can Bill CPT Code 98975?

Eligible Healthcare Professionals

• Physical Therapists (PTs)
• Occupational Therapists (OTs)
• Respiratory Therapists (RTs)
• Chiropractors
• Nurse Practitioners (NPs) & Physician Assistants (PAs)
• Other Qualified Nonphysician Healthcare Providers

Applicable Healthcare Settings

• Outpatient Rehabilitation Clinics
• Home Health Services
• Telehealth & Remote Patient Monitoring Platforms
• Hospitals & Skilled Nursing Facilities (SNFs)

Related CPT Codes for Remote Therapeutic Monitoring

Codes Frequently Billed with CPT 98975

Comparison with Similar CPT Codes

Step-by-Step Billing Method for CPT Code 98975

1. Verify Patient Eligibility & Medical Necessity

• The patient must be undergoing treatment requiring remote monitoring.
• Ensure a medically necessary ICD-10 diagnosis supports the claim.

2. Complete Initial RTM Device Setup & Education

• Configure the RTM device and link it to the patient’s treatment plan.
• Provide comprehensive training on how to use the device.

3. Document the Setup & Education Process

• Include device details, patient training steps, and expected outcomes.
• Record date, time, and duration of the training session.

4. Submit the Claim with Proper Modifiers

• Modifier 95 – If provided through telehealth.
• Modifier 59 – If billed separately from other services.

Reimbursement Guidelines for CPT Code 98975

Insurance & Medicare Coverage

• Medicare covers CPT 98975 when remote therapeutic monitoring is medically necessary.
• Private insurers may require pre-authorization for RTM services.
• Medicaid coverage varies by state.

Documentation Requirements for Successful Claims

• Device setup details & purpose of RTM
• Patient education and training summary
• Link to an ICD-10 diagnosis

How to Maximize Reimbursement for CPT Code 98975

Best Practices

• Ensure clear documentation of RTM device setup & training.
• Use ICD-10 codes that justify the medical necessity of remote monitoring.
• Educate patients on the benefits of RTM to improve adherence.

Commonly Approved Modifiers for CPT 98975

• Modifier 95 – Telehealth delivery
• Modifier 59 – If separately billed from other services

Case Studies

Real-World Applications of CPT Code 98975

Case 1: RTM for Post-Surgical Knee Rehabilitation

Scenario: A 62-year-old patient recovering from knee replacement surgery needed remote monitoring of physical therapy exercises.
Process: A physical therapist set up an RTM device, educated the patient on usage, and monitored exercise adherence remotely.
Outcome: The patient maintained therapy compliance, improving recovery, and Medicare reimbursed CPT 98975.

Case 2: RTM for COPD Management

Scenario: A 70-year-old COPD patient was prescribed a respiratory RTM device to track oxygen saturation and breathing patterns.
Process: A respiratory therapist set up the device and trained the patient on proper usage.
Outcome: The patient’s symptoms were better managed, reducing ER visits, and insurance covered CPT 98975.

Common Billing Mistakes and How to Avoid Them

Frequent Coding Errors & Claim Denials

• Not documenting patient education & setup details.
• Billing CPT 98975 for new patients without an established treatment plan.
• Failing to link an ICD-10 diagnosis that supports RTM.

Strategies to Prevent Errors

• Always include RTM device setup details in clinical documentation.
• Ensure proper ICD-10 coding and medical necessity documentation.

Conclusion

CPT 98975 is a critical code for remote therapeutic monitoring, allowing providers to enhance patient engagement and treatment adherence through digital health solutions. Proper documentation and billing compliance ensure successful reimbursement and improved patient outcomes.

FAQs

Is CPT 98975 covered by Medicare?

Yes, if medically necessary and properly documented.

What devices qualify for RTM under CPT 98975?

Devices tracking musculoskeletal, respiratory, or therapy adherence data.

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