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Difference Between RPM and RTM in CMS Codes

Understanding the difference between RPM and RTM, as well as how these terms relate to CMS codes, is essential for healthcare providers and practices seeking reimbursement for remote care services.

Understanding the Difference Between RPM and RTM: A Guide to CMS Codes and Their Applications

In the rapidly evolving world of healthcare, technology plays a pivotal role in enhancing patient care and improving outcomes. Among the various technological advancements, Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) have become increasingly prominent. These two approaches use digital tools to track patients’ health remotely, but they serve distinct purposes and are governed by different billing codes under the Centers for Medicare and Medicaid Services (CMS). Understanding the difference between RPM and RTM, as well as how these terms relate to CMS codes, is essential for healthcare providers and practices seeking reimbursement for remote care services.

What is Remote Patient Monitoring (RPM)?

Remote Patient Monitoring (RPM) is a healthcare delivery model that enables healthcare providers to monitor patients’ health outside of traditional clinical settings using digital technologies. RPM involves collecting various patient health data (such as blood pressure, glucose levels, weight, oxygen saturation, or heart rate) and transmitting this data to healthcare providers for analysis. This approach helps manage chronic conditions like diabetes, hypertension, and heart disease, ultimately improving patient outcomes and reducing hospital readmissions.

Key Features of RPM:

Data Collection: RPM tools typically collect physiological data such as vital signs (e.g., blood pressure, heart rate), glucose levels, and other health metrics.
Patient Monitoring: This data is transmitted to healthcare providers, who can track patient progress, adjust treatment plans, and intervene if necessary.
Chronic Disease Management: RPM is particularly useful for managing patients with chronic conditions, as it allows for continuous monitoring and early detection of health problems.
Patient Engagement: RPM encourages patients to take an active role in their health by using devices to track their own data, often leading to better adherence to treatment plans.

What is Remote Therapeutic Monitoring (RTM)?

Remote Therapeutic Monitoring (RTM), while similar to RPM, focuses more on monitoring and tracking specific therapeutic interventions, such as physical therapy, occupational therapy, and musculoskeletal treatments. RTM is used to assess how well a patient is responding to prescribed therapeutic treatments and to track progress in managing conditions like musculoskeletal injuries, rehabilitation, or other therapeutic regimens.

Key Features of RTM:

Therapeutic Focus: RTM is more narrowly focused on the effectiveness of therapeutic treatments and interventions, rather than on general health metrics like blood pressure or glucose levels.
Monitoring Devices: RTM involves the use of devices to track patients’ adherence to prescribed therapeutic plans, including monitoring how patients perform exercises or rehabilitation routines.
Intervention and Adjustments: Data from RTM systems allows providers to adjust therapeutic plans in real time, ensuring that treatment remains effective and tailored to the patient’s progress.
Rehabilitation and Recovery: RTM plays a critical role in monitoring recovery from surgeries or physical therapy, ensuring that patients are following their prescribed regimen and improving at the desired rate.

Key Differences Between RPM and RTM

While RPM and RTM both rely on remote technology to monitor patients, there are fundamental differences between the two:

Feature	RPM (Remote Patient Monitoring)	RTM (Remote Therapeutic Monitoring)
Primary Focus	Chronic disease management, such as hypertension, diabetes, etc.	Therapeutic interventions, such as physical therapy and rehab
Data Collected	Physiological data (e.g., blood pressure, glucose, heart rate)	Therapeutic data (e.g., rehabilitation exercises, musculoskeletal tracking)
Treatment Approach	Focuses on ongoing disease management and condition monitoring	Focuses on monitoring progress and adherence to therapeutic treatment
Example Conditions	Hypertension, diabetes, asthma, heart disease	Musculoskeletal injuries, physical therapy, post-surgical recovery

CMS Codes for RPM and RTM

The Centers for Medicare and Medicaid Services (CMS) has established specific codes for both RPM and RTM to ensure proper reimbursement for healthcare providers who offer these remote monitoring services. Understanding these codes is essential for accurate billing and reimbursement.

RPM Codes (CMS-approved):

CPT Code 99457: This code is used for remote patient monitoring services and refers to the management of chronic conditions through the use of remote monitoring technology. It typically includes at least 20 minutes of remote monitoring, patient education, and care coordination.
CPT Code 99458: An add-on code to 99457, used when there are additional 20-minute increments of time spent on remote monitoring and management.
CPT Code 99439: This code is used for remote monitoring of a single chronic condition with the collection and transmission of data.

RTM Codes (CMS-approved):

RTM codes, introduced more recently, focus on therapeutic monitoring. These codes are designed to cover services related to rehabilitation or physical therapy that are monitored remotely. Some of the key RTM codes include:

CPT Code 98975: This code is used for the initial setup and patient education for remote therapeutic monitoring. It involves the use of devices to track therapeutic treatment and monitor patient progress.
CPT Code 98976: This code is for the monthly monitoring of therapeutic data for a specific condition, such as physical therapy progress or musculoskeletal recovery.
CPT Code 98977: This code covers additional therapeutic monitoring for a different treatment, such as monitoring for multiple musculoskeletal conditions or rehabilitation treatments.

Key Differences in CMS Codes for RPM and RTM:

Service	RPM Codes	RTM Codes
Monitoring Chronic Conditions	CPT 99457, 99458, 99439	Not applicable
Therapeutic Monitoring	Not applicable	CPT 98975, 98976, 98977
Patient Education & Setup	Part of CPT 99457	Part of CPT 98975

Billing and Reimbursement

When it comes to billing, it is essential for healthcare providers to use the correct CMS codes for either RPM or RTM to ensure they are reimbursed for the services provided. The reimbursement for these services typically requires documentation of time spent on monitoring, patient interaction, and the therapeutic or disease management approach.

For RPM, providers must document that at least 20 minutes of monitoring, patient education, or care coordination were provided in a given month for proper reimbursement under the CPT 99457 and 99458 codes.
For RTM, similar documentation of time and specific therapeutic goals (e.g., adherence to physical therapy or musculoskeletal monitoring) must be provided for CPT 98975, 98976, and 98977.

Both RPM and RTM are part of the broader trend of telehealth expansion, where remote monitoring and management are becoming standard practices in chronic disease and therapeutic treatment.

While Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) both leverage digital tools to monitor patients remotely, they cater to different aspects of patient care—RPM is focused on managing chronic conditions, while RTM is more specialized in monitoring therapeutic progress. Healthcare providers must understand the distinction between these two approaches and use the correct CMS codes for accurate billing and reimbursement. By navigating these codes properly, providers can ensure they are compensated for the care they offer, improving patient outcomes and advancing the integration of technology in healthcare.

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