Pioneers in Remote Therapeutic Monitoring (RTM) Software for Physical Therapists

Remote Therapeutic Monitoring Billing Resources

This document is designed to help educate a physical therapy billing specialist on the new CPT codes for RTM and resources available to better understand the process. MovementRx does not provide billing services but can help support the billing team.

1. Educational Resources
   1. Rick Gawenda (The Guy who wrote the RTM codes for CMS) FAQ section htps://gawendaseminars.com/faq/remote-therapeutic-monitoring/
   2. Rick Gawenda Full Presentation on RTM htps://gawendaseminars.com/product/remote-therapeutic-monitoring-for-outpatient-physical-and-occupational-therapy-in-2023/
   3. MovementRx Summary of Gawenda Presentation htps://youtu.be/aG0m-E4WJ60
2. RTM Payment
   1. Traditional Medicare has given all 5 of the RTM codes a status indicator of “A” which means it’s an Active Code
   2. These codes are separately paid under the physician fee schedule
   3. RTM is a covered service, but that the MACs may assess claims to determine whether the service complies with the billing rules, etc., as the MACs would for any item/service reimbursable by Medicare
   4. Currently, there are no active local coverage determinations for RTM or for Remote Physiological Monitoring (RPM) in review of the MACs websites
   5. Medicare Advantage plans, at minimum, must provide and cover the same services as traditional Medicare
   6. RTM coverage and payment for commercial insurance carriers are unique to the insurance. Currently Nationwide Blue Cross Blue Shield, Aetna and United Healthcare have policies stating they reimburse for RTM
   7. Each commercial insurer makes their own determination of coverage. We recommend requesting a policy document from each commercial insurer to understand better their policies.
3. RTM Claim Form Completion
   1. On 1500-claim form, use Place of Service code 11 or 12 dependent upon where the patient was seen for their initial evaluation and subsequent follow-up therapy visits
   2. On UB-04 claim form, use revenue code 420 for physical therapy, 430 for occupational therapy and 440 for speech therapy.
   3. On a UB-04 claim form, some Medicare Administrative Contractors and commercial insurance carriers may also accept revenue code 421 for physical therapy, 431 for occupational therapy and 441 for speech therapy.
4. Submitting Claims through your EMR
   1. Every EMR system is different. It is our recommendation that you reach our directly to your EMR company and discuss how to properly submit the codes produced for RTM. All supporting documentation lives in the MovementRX system and can be downloaded if needed as supporting documentation. Watch the video here to learn more. htps://youtu.be/du-m1AuO4QU
   2. It is our recommendation that you do not submit a claim for RTM on the same day as a normal service date for PT to avoid a denial of that RTM claim.
5. Medicare RTM Code Descriptions