Elevate your chronic respiratory care

Take the guesswork out of understanding patient adherence and disease control

About Remote Therapeutic Monitoring

Remote Therapeutic Monitoring (RTM) is the use of digital technologies to collect and monitor non-physiologic health data – such as medication use and adherence – from patients with chronic diseases. In chronic respiratory care, medication monitoring provides enhanced visibility into adherence, which is critical for improving patient outcomes.1 Objective insights can help clinicians identify patients who may be at risk for an exacerbation and prompt timely interventions, reducing unnecessary hospitalizations and ED visits.2

The Centers for Medicare and Medicaid Services (CMS) now provides reimbursement for RTM under five new CPT codes – 98975, 98976, 98977, 98980 and 98981.3 These new RTM codes, adopted by CMS in the 2022 Medicare Physician Fee Schedule, allow healthcare providers to seek reimbursement for qualifying remote monitoring of respiratory conditions between patient visits.

Propeller provides clear data on your respiratory patients’ medication adherence, a leading indicator of quality outcomes.4

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Monitor your patient panel and help make informed treatment decisions for your most challenging patients with access to objective data

Enhance care coordination and reduce administrative burden by proactively identifying patients who may need an intervention

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Empower your patients to better manage their own condition through routine monitoring and engagement tools

The Propeller Solution

Give your RTM program an edge with Propeller

Inhaler Sensor & Cellular Hub

Propeller sensors and hubs work together to collect patient medication adherence data and feed information to you and your patients through the Clinician and Patient Portals.

A desktop computer showing Propeller Health Clinician Portal

Clinician Portal

View rescue inhaler use and controller adherence data for each patient in your panel and receive email notifications for patients who may be at risk for exacerbations.

Patient Portal and Mobile App*

Patients can view their medication adherence data, download reports and view educational content to help them manage their respiratory condition.

*Subject to the patient’s agreement to Propeller’s End User Terms and Privacy Notice

Remote monitoring programs are proven to improve health outcomes

Reduced Rescue Inhaler Usage

Reductions in rescue inhaler use may indicate more days without symptoms and a better quality of life.

At 12 months of use, Propeller users saw1:

absolute improvement in rescue inhaler-free days

reduction in mean rescue inhaler puffs per day

reduction in nighttime rescue inhaler use

Study design
Quality improvement program

Participants
190 Medicare-eligible adults with COPD

COPD outcomes chart

Want to learn how Propeller’s solution can support your RTM program?

CPT RTM Code Requirements

HCPCSDescription2022 Medicare Physician Fee Schedule (MPFS) national payment amount

Non-facility price*

98975Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment$19
98976Remote 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 respiratory system, each 30 days$56
98980Remote 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$50
98981Remote 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$41

Medicare Program; CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; and Provider and Supplier Prepayment and Post-Payment Medical Review Requirements; Final Rule https://www.govinfo.gov/content/pkg/FR-2021-11-19/pdf/2021-23972.pdf

*This column includes the fee schedule amount when a physician performs a procedure in a non-facility setting such as an office. 2022 facility fee schedule pricing, such as when a physician provides the service in a hospital, can be found at https://www.cms.gov/medicare/physician-fee-schedule/search Data sourced from CMS and may differ by geography. This information should be used directionally only.

The information on this site is intended to provide education and resources for assessing Medicare coverage available for remote therapeutic monitoring. Neither Propeller Health nor ResMed guarantee any coverage or reimbursement for RTM services using the Propeller system. You are responsible for ensuring that applicable payor coverage criteria are met for each patient service for which payment is sought. Please be advised that each payor may have different requirements for coverage and reimbursement of RTM services and you should consult the available payor guidance to confirm eligibility for billing.  This guidance is not intended to provide any legal or billing arising from or relating to your use of this resource for purposes of billing. ResMed and Propeller Health are not responsible for your use of the information provided on this page, and are not liable for any adverse position taken by any private or public insurer with respect to remote therapeutic monitoring.

RTM FAQ

RTM may be a beneficial option for any practice delivering healthcare for those experiencing high incidence of COPD, and/or chronic asthma. Propeller provides clinicians objective data on their patients’ medication adherence, triggers and exacerbations, to help enable informed care decisions and have open conversations with patients.

According to the CMS 2021 final rule Remote Physiologic Monitoring codes involve the collection of physiologic patient data to guide treatment plans.4 The main differences are the types of data collected and how. RTM codes allow for the monitoring of “non-physiologic data” focusing on patient data through signs, symptoms and functions of a therapeutic response (e.g. therapy adherence and response). RPM codes focus on physiologic data that is generally understood to be parameters generated by the body (e.g. ECG, blood pressure, etc.) that are detectable by a signal acquisition medical device/system. RTM data can be patient reported and digitally uploaded, while RPM data can only be digitally uploaded. For both sets of codes, the device used must meet the FDA definition of a device as described in section 201(h) of the Federal Food, Drug and Cosmetic Act (FFDCA).4 Propeller’s inhaler sensors meet this definition and have received FDA clearance.

RTM codes are classified as General Medicine services. Physicians and eligible qualified healthcare professionals (including but not limited to therapists, physiatrists, nurse practitioners, and other practitioners with Medicare billing privileges) are permitted to bill using the RTM codes. Where the practitioner’s Medicare benefit does not include services furnished incident to their professional services, the items and services described by these codes must be furnished directly by the billing practitioner or, in the case of a physical therapist or occupational therapist, by a therapy assistant under the physical therapist’s or occupational therapist’s supervision.4.1

No.  Because RTM codes are considered general medicine services instead of evaluation and management services, they cannot be considered care management services.4 A physician cannot order and bill for RTM services when work is being done remotely by clinical staff or auxiliary personnel under general supervision.

No, physicians cannot bill for the same patient for both RTM and RPM in the same 30 day period.4 Providers should work with a billing expert to consider which patients in their panel would be better served by RTM or RPM.

In order to bill for RTM (i.e., 98975, 98976, 98977), a medical device must monitor at least 16 days of medication event data per 30-day period.

In order to submit a claim that includes RTM codes (i.e., 98975, 98976, 98977), your patient must use a medical device to monitor at least 16 days of medication event data per 30-day period.4

Code 98980 requires at least one interactive communication as part of the 20 minute billing increment between the physician or billing provider and the patient/caregiver. Code 98981 is used for each additional 20 minutes thereafter.4

RTM codes may be able to be billed during the same service period as chronic care management services, transitional care management services, principle care management services and behavioral health integration services.4 Work with a billing advisor or other expert to help determine whether it is appropriate to bill different combinations of codes.

Discover whether Propeller is right for your remote monitoring program

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SOURCES:

[1] Chen et al. Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis. JMIR Form Res, 2019. [2] Busse et al. Insights from the AUSTRI study on reliever use before and after asthma exacerbations. J Allergy Clin Immunol Pract, 2022. [3] Section 65115 of CMS,“Medicare Program, CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies” Final Rule. November 2021. (Link) [3.1] Section 65116 of CMS,“Medicare Program, CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies” Final Rule. November 202. (Link) [4] Stempel et al. Defining Optimal Medication Adherence for Persistent Asthma and COPD. J Allergy Clin Immunol Pract, 2021.

DISCLAIMER: 

The information on this site is being provided on an “as is” basis with no express or implied warranty of any kind and should be used for your internal informational purposes only. The information provided does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. ResMed does not represent or warrant that any of the information being provided is true or correct, or any outcome of using the information presented in the document. You agree to hold ResMed harmless in the event of any loss, damage, liabilities or claims arising from the use of the reimbursement information provided to you. Before filing any claims, it is your sole responsibility to verify current requirements and coverage policies with the applicable payer. Please note that coverage and reimbursement policies may differ by payor and it is your responsibility to ensure that all applicable payor criteria are met prior to billing.

Current Procedural Terminology (CPT®) copyright 2020 American Medical Association, all rights reserved. CPT is used with permission of the American Medical Association. You cannot, without permission from the American Medical Association, copy, modify, distribute, display, or use CPT for any commercial purpose, including for productive use in a clinical setting. Any such use requires a separate license from the AMA. Inclusion of the CPT codes listed does not constitute endorsement by the American Medical Association for any specific purpose identified in this publication. The American Medical Association does not dictate payer reimbursement policy, and does not substitute for the professional judgment of the practitioner performing a procedure, who remains responsible for correct coding. The AMA disclaims any and all liability for any errors in the CPT codes and for any consequences attributable to or related to any uses, nonuse, or interpretation of information contained in or not contained in the CPT codes. The AMA is not engaged in the practice of medicine or dispensing medical services. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.