When using PatchRx, it is critical to understand how each RTM code works and each of the steps necessary to complete in order to bill for these codes. Below, we break down each RTM code, how your billing team can track it in PatchRx's web portal, and the different steps that need to be taken in order to be reimbursed for each of them.
CPT® code 98975 (~$18)
Definition: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment
This would equate to the setup of a PatchCap and gateway, and education to the patient on how to use the PatchCap and gateway to track their medication compliance. Unlike other codes, this code can only be billed once every 365 days. Additionally, this code can not be billed until after 16 days of data have been received from the patient, meaning that it should only be submitted once 98977 is completed.
In PatchRx, we store the day the patient is added as the day that the patient was educated on the PatchRx system. During the add patient process, there is a checkbox in which the patient must agree that they received education on how to use the PatchCap and Gateway device. Their response to this checkbox is required in order to be added to PatchRx, and is stored in our database.
After the first 16 days of data are reported for this patient, you will be able to export this billing code to be uploaded to the patient's EHR for billing purposes.
CPT® code 98977 ($54)
Definition: Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
This code is specific to diagnoses that fall under the category of “Musculoskeletal”. This distinction is important to make in the setup process of RTM as only musculoskeletal conditions are eligible for billing under code 98977. You can also bill for code 98976 for respiratory patients, but as pain patients typically fall into the musculoskeletal category, we have excluded it from this guide.
This code requires that we are remotely receiving data on the patient's medication compliance over a course of 30 days and requires that we receive data for at least 16/30 days. Once we have received 16 days' worth of data, you will also be able to bill for code 98977. This is also tracked based on the patient setup date for the first 30 day cycle. After the first 30 days are completed, we restart data tracking for code 98977 starting on day 31, and so on for the duration of the patient's remote monitoring.
CPT® code 98980 ($48)
Definition: Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.
This code is specific to the remote interactions that need to be had with a patient over the course of remote monitoring. These are billed on a calendar month basis, unlike codes 98976-77 which are billed on a 30-day basis. A practitioner can only complete this code one time per month. This code requires at least one of these monitoring sessions to be a patient interaction.
In PatchRx, you will be able to track your patient monitoring sessions under the Billing-To-Do section. By clicking the button titled "Take Action" you will be able to choose between logging a monitoring session or starting a live monitoring session. With logged monitoring sessions, you will be able to log notes from an interaction that you had with the patient or add notes that you have taken while reviewing the patient's compliance data during a compliance monitoring session, and you will be able to add the time that you spent doing so. With a live monitoring session, you will be able to start a timer to track the time spent speaking with a patient or monitoring their data, as well as tracking which type of monitoring session it was and taking notes. We will automatically track your monitoring sessions to ensure that you complete both the patient interaction and the 20 minutes worth of patient monitoring in order to bill for code 98980.
When a calendar month rolls over to the following month, code 98980 will be reset down to 0 minutes of interaction and 0 patient interactions, as you are unable to roll over time from incomplete codes spent working with a patient to the following month.
CPT® code 98981 ($39)
Definition: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes
This code is very similar to 98980 but is only accessible after code 98980 has been completed. There is one key difference with code 98981, in that you are able to bill for this code two times per calendar month, for a total of $78 in reimbursement revenue. This code still requires 20 minutes of total monitoring and one patient interaction to be billed.
In PatchRx, when you complete the first 20 minutes of monitoring in a calendar month (associated with code 98980), PatchRx will then begin tracking future interactions with code 98981. Once you complete your second 20 minutes of monitoring and patient interaction, minutes will begin rolling over to the second billable cycle of 98981.
Between 98980 and 98981, you are able to bill for 3 separate 20-minute cycles of monitoring and interactions with the patient for a total of $126 per patient per calendar month.
When a calendar month rolls over to the following month, similar to 98980, code 98981 will be reset down to 0 minutes of interaction and 0 patient interactions, as you are unable to roll over time from incomplete codes spent working with a patient to the following month.
If you have additional questions on how RTM billing codes work or how to bill for them on PatchRx, please contact us at (918) 727-2962, at email@example.com, or on our website or app chat.