CPT Codes 98980 & 98981: Complete Guide to Billing, Reimbursement, and Compliance

Introduction

In the ever-evolving world of medical billing, understanding Current Procedural Terminology (CPT) codes is crucial for healthcare providers to ensure accurate reimbursement and compliance. CPT codes 98980 and 98981 specifically relate to remote therapeutic monitoring (RTM), a growing area in telemedicine that allows healthcare professionals to track patient progress outside of traditional in-person visits.

This article will break down CPT codes 98980 and 98981, explaining their definitions, importance, billing process, and how to maximize reimbursement while avoiding common billing mistakes.

What Are CPT Codes 98980 and 98981?

Definition and Purpose

CPT 98980 and 98981 are codes used for remote therapeutic monitoring (RTM) treatment management services. These codes allow healthcare providers to track a patient's response to therapy and adjust treatments as needed.

• CPT 98980: Covers the first 20 minutes of remote therapeutic monitoring treatment management services per month.
• CPT 98981: Covers each additional 20 minutes of RTM services within the same month.

These codes are primarily used for non-physician healthcare providers, including physical therapists, occupational therapists, and clinical psychologists, who use remote monitoring technologies to collect and analyze patient data.

Importance of CPT Codes 98980 and 98981 in Medical Billing and Coding

With the increasing demand for remote patient care, these CPT codes play a crucial role in ensuring providers get paid for time spent analyzing data, communicating with patients, and adjusting treatment plans.

• Enhances continuity of care between in-person visits
• Allows providers to identify and address patient concerns early
• Supports better health outcomes through proactive monitoring
• Enables providers to get reimbursed for non-face-to-face care

As telehealth and digital health technologies continue to grow, understanding how to properly use and bill 98980 and 98981 is essential for maximizing reimbursement.

Common Medical Conditions Treated with CPT 98980 and 98981

RTM services are often used to track patient progress for a variety of conditions, including:

Musculoskeletal and Physical Therapy Conditions

• Post-surgical rehabilitation (knee replacement, rotator cuff surgery)
• Chronic pain management (arthritis, fibromyalgia)
• Spinal disorders (scoliosis, lower back pain)

Respiratory and Pulmonary Conditions

• COPD and asthma management
• Pulmonary rehabilitation programs

Neurological and Behavioral Health Conditions

• Stroke recovery and rehabilitation
• Mental health and cognitive therapy
• Chronic pain and opioid use monitoring

By using CPT 98980 and 98981, healthcare professionals can monitor how well patients adhere to therapy programs, track symptoms, and adjust treatment plans accordingly.

Who Can Bill CPT Codes 98980 and 98981?

Healthcare Professionals Eligible to Use These Codes

Unlike some other remote monitoring codes, CPT 98980 and 98981 are designed primarily for non-physician healthcare providers, such as:

• Physical Therapists (PTs)
• Occupational Therapists (OTs)
• Speech-Language Pathologists (SLPs)
• Clinical Social Workers and Psychologists
• Nurse Practitioners (NPs) and Physician Assistants (PAs)

Settings Where These Codes Are Applicable

These codes can be used in various healthcare settings, including:

• Hospitals and Outpatient Clinics
• Home Health Settings
• Telehealth and Virtual Therapy Programs

Because RTM codes allow providers to bill for non-face-to-face interactions, they are increasingly utilized in telemedicine, chronic care management, and post-surgical rehabilitation programs.

Related CPT Codes with 98980 and 98981 (Respective Treatments)

While billing for CPT 98980 and 98981, it is essential to know related CPT codes that are frequently used alongside them:

Comparison with Similar CPT Codes

Understanding which codes to use and when is crucial for maximizing reimbursement.

Step-by-Step Billing Method for CPT Code 98980 and 98981

Billing for these codes requires accurate documentation and adherence to payer policies. Here’s how:

1. Ensure patient eligibility: Confirm that the patient qualifies for remote therapeutic monitoring.
2. Use the correct code:
   
   • Bill 98980 for the first 20 minutes per month.
   • Use 98981 for each additional 20-minute increment.
3. Document the service provided: Record patient interactions, data analysis, and treatment modifications.
4. Submit claims with appropriate modifiers (if needed).

Reimbursement Guidelines for CPT 98980 and 98981

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 covers RTM services when properly documented.
• Private insurers may have different rules—check policies before billing.
• Medicaid coverage varies by state—confirm requirements beforehand.

Documentation Requirements for Successful Claims

• Time spent monitoring and managing the patient
• Analysis of therapeutic data
• Clinical decisions made based on the data

Failing to document these elements can lead to claim denials.

How to Maximize Reimbursement for CPT 98980 and 98981

Best Practices

• Use automated tracking tools for RTM documentation
• Train billing staff to apply correct modifiers
• Stay updated with insurance policies

Commonly Approved Modifiers

Common Billing Mistakes and How to Avoid Them

Frequent Coding Errors

• Incorrect use of CPT 98980 vs. 98981
• Failure to document 20-minute time requirements
• Billing RTM services without patient consent

Strategies to Prevent Billing Mistakes

• Verify payer requirements before submitting claims
• Train staff on RTM-specific documentation
• Conduct internal audits to ensure compliance

Conclusion

CPT codes 98980 and 98981 offer healthcare providers a reliable way to bill for remote therapeutic monitoring services. By ensuring proper documentation, correct coding, and compliance with payer guidelines, providers can maximize reimbursement while enhancing patient care.

FAQs

1. Who can bill for CPT 98980 and 98981?
   Non-physician healthcare providers, including PTs, OTs, and psychologists.
2. Are CPT codes 98980 and 98981 covered by Medicare?
   Yes, but providers must meet Medicare's RTM documentation requirements.
3. Can these codes be used for telehealth?
   Yes, RTM codes support remote patient care and can be billed for telemedicine services.
4. What is the difference between 98980 and 98981?
   98980 covers the first 20 minutes per month, while 98981 covers each additional 20 minutes.
5. How can I avoid claim denials?
   Ensure proper documentation of time spent, patient consent, and payer guidelines compliance.

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