More good news for providers and patients under Medicare: Medicare administrative contractors, or MACs, will follow the recommendations of APTA and other organizations and not move toward developing local coverage determinations for remote therapeutic monitoring. The win came after APTA and others participated in a meeting of MACs in February.
What it means: For the time being, Medicare fee-for-service beneficiaries can expect coverage of RTM and remote physiologic monitoring procedures, and PTs can continue to bill for RTM codes under the Medicare Physician Fee Schedule. The decision was announced in a recent email from the MACs and a post on MAC websites.
The decision came after a Feb. 28 meeting of the Multijurisdictional Contractor Advisory Committee to discuss the potential development of a local coverage determination, or LCD, for RTM. During the meeting, the committee members specifically sought input from APTA and other organizations on the pros and cons of adopting an LCD.
Alice Bell, PT, DPT, APTA senior specialist for health policy and payment, served as a subject matter expert panelist and offered input on the clinical importance of RTM along with evidence to support its use by PTs. Other APTA representatives were on hand to add to Bell's perspective, advocating against adopting local policies that would create patchwork coverage.
"Remote therapeutic monitoring provides an opportunity to enhance the care offered by physical therapists," Bell said. "It can be a very useful tool to ensure that the plan of care is optimized, goals are achieved in a timely manner, and a patient is able to sustain self-management during the course of and after discharge from therapy, and APTA is pleased that the MACs recognize the patient benefits."
PTs were first added to the list of providers able to bill for RTM in 2022. Since then APTA has successfully worked with the U.S. Centers for Medicare & Medicaid Services around code denials made in error by some MACs. The association also offers a practice advisory on RTM, an APTA member benefit that includes background on the codes, descriptions of each, documentation requirements, and guidance on which codes are subject to payment adjustment under the PTA differential system, as well as real-world examples that clarify application.