Note: Since the publication of this article, CMS has acknowledged that denials for CPT codes 98980 and 98981 were made in error, and that it will be making corrections. Providers who received denials for these codes are advised to resubmit claims. This April 14 article provides more details.
While it's been more than a year since PTs were included in the list of providers able to bill for several remote therapeutic monitoring codes under the Medicare Physician Fee Schedule, details continue to be worked out — and possible changes discussed. APTA pursues those details and remains at the table for important conversations around what may or may not happen next.
Here's the latest on the PT's use of RTM under the fee schedule.
We've Updated the APTA Practice Advisory on RTM
In response to questions from members, APTA added more information to the practice advisory we published soon after the U.S. Centers for Medicare & Medicaid Services announced it would extend use of two sets of CPT codes related to RTM for use by PTs. The new information provides additional insight on billing requirements and PTA supervision.
We're Advocating for Continued Patient Access to RTM by PTs
APTA staff and member representatives participated in a recent Medicare Contractor Advisory Committee meeting to discuss the application of remote therapeutic monitoring in physical therapist practice. Generally speaking, these committee meetings are intended to be a platform for communication between providers and Medicare contractors; the Feb. 28 meeting was focused on soliciting input from subject matter experts about the use of physiologic monitoring and RTM. The aim of the meeting: To find out if it would be a good idea to establish a local coverage determination for these services. APTA made the case for no LCD, with our representatives sharing the association’s position that an LCD could interfere with patient access to these important services. APTA will submit comments as a follow-up to the call.
We're Working to Clear up Confusion Among MACs Around RTM Codes
APTA is communicating with Medicare Administrative Contractors — aka MACs — to address an apparent error in claims processing related to denials of services that should be covered. Specifically, since Jan. 1, 2023, when facilities have submitted claims for RTM on a UB-04 claim form, the MACs have accepted claims for codes 98975, 98976, and 98977 but denied codes 98980 and 98981, asserting that they're non-covered services. This is incorrect. APTA reached out to the MACs and is working with a representative from the Critical Inquiries Unit to address the error. APTA staff will provide updates as available. (Note: APTA's communications with CMS resulted in the agency acknowledging that the denials were made in error. Providers who received denials are advised to resubmit relevant claims.)