CPT Code 98977: Remote Therapeutic Monitoring - A Comprehensive Guide

Introduction

With the rise of remote healthcare and digital health technologies, CPT Code 98977 has become increasingly relevant in medical billing and coding. This code is used for remote therapeutic monitoring (RTM) of respiratory system parameters using a patient-supplied device.

In this article, we will explore the definition, usage, billing guidelines, reimbursement policies, and common mistakes associated with CPT Code 98977. Understanding this code can help healthcare providers ensure accurate claims submission, maximize reimbursement and improve patient outcomes.

What is CPT Code 98977?

Definition and Purpose

CPT Code 98977 is used for remote therapeutic monitoring (RTM) of the respiratory system, which includes conditions such as asthma, COPD, and other lung diseases. It involves the use of a digital health device that collects and transmits data to a healthcare provider for evaluation and management.

The key aspects of CPT Code 98977 include:

• Monitoring respiratory health data remotely.
• Tracking patient progress and adherence to therapy.
• Providing feedback to patients based on the collected data.
• Enhancing patient engagement and outcomes by using digital tools.

Importance of CPT Code 98977 in Medical Billing and Coding

This code is vital for accurate reimbursement and documentation of remote monitoring services. It allows healthcare providers to:

• Bill for remote patient monitoring and digital therapeutic interventions.
• Improve patient compliance and disease management through real-time feedback.
• Reduce hospital readmissions by closely monitoring at-risk patients.
• Enhance Medicare and private insurance reimbursement for remote healthcare services.

With the increasing shift towards telemedicine and digital health, CPT 98977 ensures providers are compensated for their efforts in delivering virtual respiratory therapy monitoring.

Common Medical Conditions Treated with CPT Code 98977

CPT Code 98977 is commonly used for chronic respiratory diseases that require ongoing monitoring. Conditions that benefit from remote therapeutic monitoring include:

• Chronic Obstructive Pulmonary Disease (COPD) – Tracking oxygen levels and breathing patterns.
• Asthma – Monitoring peak flow measurements and medication adherence.
• Sleep Apnea – Evaluating respiratory rates and therapy compliance.
• Cystic Fibrosis – Assessing lung function and therapy adherence.
• Post-COVID-19 Lung Damage – Monitoring oxygen saturation and respiratory function.
• Interstitial Lung Disease – Measuring lung function over time.

By using CPT 98977, providers can continuously monitor patient data, detect early warning signs of deterioration, and adjust treatment plans accordingly.

Who Can Bill CPT Code 98977?

Healthcare Professionals Eligible to Use This Code

CPT Code 98977 can be billed by qualified healthcare providers, including:

• Physicians (Pulmonologists, Primary Care, and Specialists)
• Respiratory Therapists
• Nurse Practitioners (NPs) and Physician Assistants (PAs)
• Physical Therapists (PTs) and Occupational Therapists (OTs) (if managing respiratory therapy)
• Clinical Pharmacists (for medication therapy monitoring)

Settings Where This Code is Applicable

CPT 98977 can be billed in various healthcare settings, including:

• Hospitals and Outpatient Clinics
• Telemedicine and Digital Health Services
• Pulmonology and Respiratory Therapy Centers
• Home Health and Remote Patient Monitoring Programs

Many Medicare and private insurance plans now cover RTM services, expanding its applicability in virtual healthcare settings.

Related CPT Codes with 98977 (Respective Treatments)

Codes Frequently Billed Together

CPT Code 98977 is often billed alongside other remote monitoring and digital health codes, such as:

• 99457 – Remote patient monitoring (RPM) treatment management services.
• 99454 – Remote monitoring of physiological parameters.
• 98980 – Remote therapeutic monitoring, initial treatment management.
• 98981 – Remote therapeutic monitoring, additional sessions.

Comparison with Similar CPT Codes

• CPT 98976 vs. 98977 – 98976 is used for musculoskeletal monitoring, while 98977 applies to respiratory conditions.
• CPT 99457 vs. 98977 – 99457 is for RPM (remote patient monitoring), while 98977 is for RTM (remote therapeutic monitoring) for treatment adherence rather than vitals monitoring.

Understanding these differences helps avoid billing errors and optimize reimbursement.

Step-by-Step Billing Method for CPT Code 98977

1. Verify Patient Eligibility

• Confirm insurance coverage for RTM services.
• Obtain prior authorization if needed.

2. Provide and Set Up the Monitoring Device

• Prescribe an FDA-approved digital health device for respiratory monitoring.
• Ensure the patient is trained on device usage.

3. Monitor Data and Provide Treatment Adjustments

• Collect and analyze respiratory data remotely.
• Adjust treatment plans based on the patient’s real-time data.

4. Document the Monitoring and Patient Engagement

• Record therapy adherence, symptoms, and interventions.
• Maintain clear documentation for insurance claims.

5. Submit the Claim with Correct Modifiers

• Use ICD-10 codes specific to the respiratory condition.
• Apply appropriate modifiers to justify RTM billing.

Proper billing ensures faster reimbursement and fewer claim denials.

Reimbursement Guidelines for CPT Code 98977

Reimbursement Rate

Note: This reimbursement rate is average and may not reflect the actual reimbursement you receive. Always verify coverage and rates with individual payers.

Insurance and Medicare/Medicaid Policies

• Medicare Part B covers CPT 98977 for remote therapeutic monitoring if medically necessary.
• Private insurers may require prior authorization for digital health services.

Documentation Requirements for Successful Claims

• Proof of patient consent for remote monitoring.
• Daily or weekly data collection records.
• Provider’s treatment decisions are based on the data.

Proper documentation ensures maximum reimbursement and claim approval.

How to Maximize Reimbursement for CPT Code 98977

Best Practices to Ensure Full Compensation

• Use an FDA-approved remote monitoring device to comply with payer guidelines.
• Maintain detailed logs of patient engagement and interventions.
• Submit claims promptly to avoid denials due to late filing.

Commonly Approved Modifiers and Documentation Tips

• Modifier 59  – When RTM is conducted via telemedicine.
• Modifier 59 – If billed alongside other RTM or RPM codes.
• Modifier 26 – When billing for professional services.

Using correct modifiers reduces claim rejections and improves reimbursement rates.

Common Billing Mistakes and How to Avoid Them

Frequent Coding Errors and Claim Denials

• Not documenting patient consent for RTM services.
• Billing CPT 98977 for non-approved devices.
• Lack of evidence for patient engagement or therapy adherence.

Strategies to Prevent Billing Mistakes

• Stay updated on payer policies regarding RTM coverage.
• Ensure proper documentation of device usage and patient response.
• Use billing software to detect errors before claim submission.

Conclusion

CPT Code 98977 is a critical billing code for remote therapeutic monitoring of respiratory conditions, helping patients manage chronic illnesses while allowing providers to deliver digital health interventions. Proper billing, accurate documentation, and correct modifier usage are key to ensuring successful reimbursement.

FAQs

1. Can CPT Code 98977 be used for telemedicine?

Yes, if the payer allows RTM services via telehealth, CPT 98977 can be billed.

2. Does Medicare cover CPT Code 98977?

Yes, Medicare Part B covers it for medically necessary respiratory monitoring.

3. How often can CPT 98977 be billed?

It can be billed once per 30-day period per patient.

4. What devices qualify for CPT 98977 billing?

FDA-approved digital health devices for respiratory monitoring.

5. What is the reimbursement rate for CPT 98977?

Rates vary, but average $50-$120 per month, depending on the payer.

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