Our healthcare system is designed around acute interventions, resulting in little to no chronic condition support and poor adherence to treatment protocols. Given that nearly half of all Americans suffer from at least one chronic condition - this poses a tremendous problem.
Managing chronic conditions with remote care has been gaining popularity rapidly. For example, per Amwell, 96% of physicians are willing to use telehealth, with a sizable majority willing to use it for regular chronic care management check-ins (93%) and follow-up visits after surgery or hospital stays (71%).
These offerings advance virtual care, give providers more opportunities for reimbursement, and expand the use of digital health tools to provide more comprehensive data to practitioners.
The Centers for Medicare and Medicaid Services (CMS) continues to provide new reimbursement options for remote care services to help patients manage their chronic conditions from home. With an ever-growing list of acronyms, remote care technologies, and billing/coding rules, it can be hard to keep up. As a refresh:
RPM involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition. Physiological data can include vital signs like blood pressure, blood sugar, weight, SpO2 and/or heart rate information.
RTM represents one of the latest advancements to modernize reimbursement for digital health. Introduced in 2022, these codes expand upon existing RPM codes, yet specifically focus on respiratory system status, musculoskeletal system status, therapy adherence, and therapy response.
Last but not least, CCM services are generally non-face-to-face services provided to patients who have multiple (two or more) chronic conditions expected to last at least 12 months. The full CMS explanation of CCM requires at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
The coupling of RPM and CCM makes sense because they are highly complementary; RPM has the doctor access and analyze data real-time throughout the month, and CCM has the doctor intervene and guide the patient’s care throughout the month.
A patient can be eligible for both a monitoring program (either RPM or RTM) and CCM. RPM/RTM services include collecting and monitoring specific patient data, which can be a valuable asset in providing care for patients with complex conditions that are part of a CCM program.
It’s important to note that the same minutes spent providing care cannot apply to both. The time requirements for each code must be met separately and no time can be double counted.
CCM
Code
Descriptor
2022 Payment
99490
CCM, clinical staff, initial 20 min.
$64.03
99439
CCM, clinical staff, +20 min.
$48.45
99491
CCM, physician/NPP, 30 min.
$86.18
99437
CCM, physician/NPP, +30 min.
$61.26
The base CPT code for CCM, 99490, requires that patients must have two or more chronic conditions and receive at least 20 minutes of CCM services from clinical staff within a given month. A personalized care plan, which shows an assessment of all patient factors and identifies gaps and barriers to be addressed, is also required. 99490 and 99491 cannot be billed in the same month.
RPM
Code
Descriptor
2022 Payment
99453
Patient onboarding & education
$19.04
99454
Device supply
$55.72
99457
Monitoring with communication,first 20 min.
$50.18
99458
Monitoring with communication,+20 min.
$40.84
In 2019, CMS initially described RPM as services rendered to patients with chronic conditions. In 2021, it was confirmed that RPM services can be furnished to patients with acute conditions as well as those with chronic conditions.
RTM
Code
Descriptor
2022 Payment
98975
Patient onboarding & education
$19.38
98976
Device supply (respiratory system)
$55.72
98977
Device supply (musculoskeletal system)
$55.72
98980
Monitoring with communication,first 20 min.
$50.18
98980
Monitoring with communication,+20 min.
$40.84
Unlike RPM, RTM codes are general medicine codes, meaning they can be billed by providers who aren’t able to bill for evaluation and management (E/M) codes. Additionally, RTM involves non-physiologic data (unlike RPM), which can be self-reported by the patient to the billing practitioner (as opposed to requiring the data be transmitted automatically by the device).
CMS is clearly invested in the clinical and financial benefits of remote care management. RPM or RTM services are billable alongside CCM and can be easily inserted into CCM and telehealth workflows, giving providers a more comprehensive view of patient health.
To learn more about Veta Health’s comprehensive remote care offerings, talk to a member of our sales team today.