Since 2022, Medicare has expanded the remote CPT codes to help with the accessibility of remote therapeutic intervention. Cognitive rehabilitation is a crucial aspect of healthcare, helping individuals regain cognitive function and independence after neurological injuries or conditions such as strokes, traumatic brain injuries, or neurodegenerative diseases. Traditionally, cognitive rehabilitation has been conducted in clinical settings, which can be limiting for many patients due to reasons such as accessibility, scheduling conflicts, and the ongoing global pandemic. Fortunately, advancements in technology have paved the way for innovative solutions like Remote Therapeutic Monitoring (RTM) to bridge this gap.
Both rehabilitation and remediation focus on improving the cognitive functions of an individual. The main difference between the two is not in the treatment but in the cause of the cognitive deficits and the desired treatment outcomes. From an insurance standpoint, since the treatments are identical, the insurance coding is the same.
CPT Code
Description
CPT Code & Descriptions
Remote therapeutic monitoring (e.g., therapy adherence, therapy response); initial set-up and patient education on the use of equipment.
Remote therapeutic monitoring treatment management services, physician/ other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes.
Remote therapeutic monitoring treatment management services, physician/other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; each additional 20 minutes.
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Real-time Progress Tracking: HappyNeuron Pro tracks a patient’s performance on each exercise and compiles data on their progress. With RTM, therapists can access this data in real-time, allowing them to identify trends, areas of improvement, and potential challenges.
Personalized Treatment Plans: Using the data collected through HappyNeuron Pro, therapists can create highly individualized treatment plans. These plans can be adjusted as needed to ensure that patients are continually challenged and progressing in their cognitive rehabilitation.
Remote Support and Feedback: RTM enables therapists to provide remote support and feedback to patients. Whether through video calls, messages, or secure chat platforms, therapists can guide and encourage patients throughout their rehabilitation journey, even from a distance.
Motivation and Engagement: HappyNeuron Pro’s interactive exercises are designed to keep patients engaged. The platform encourages regular participation, which is essential for effective cognitive rehabilitation. Patients can track their own progress, fostering a sense of accomplishment.
CPT codes 98980 and 98981 can be billed in conjunction with the following:
Billing Practitioners cannot count the same period of time for more than one code, and no time can be counted on a day when the billing practitioner reports an E/M service for the same beneficiary.
RTM and RPM should not be billed for the same patient in the same month. The American Medical Association’s 2022 CPT Professional (“2022 CPT Manual”) states that 98980 should not be reported in conjunction with 99457.
The 2022 CPT Manual also states that CPT code 98980 cannot be reported in the same calendar month as CPT code 99091.
This varies depending on the state and insurance. But on average, fees are paid at $30 to $54 per unit.
A clinical staff member is defined in the CPT Manual as “a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation, and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that service.” This means that the type of personnel that qualify as “clinical staff” for purposes of RTM varies by state law and providers should look to the applicable scope of practice laws in the patient’s state to determine who can and cannot provide monitoring services.
Although “clinical staff” is not included in the CPT code descriptors for codes 98980 and 98981, CMS clarified that when the billing practitioner’s benefit allows services to be furnished incident-to their professional services, clinical staff can provide RTM services under direct supervision. “Direct Supervision” [KO1] means the billing practitioner must be in the exact physical office location of the clinical staff and immediately available to provide assistance when necessary.
Reimbursement can only be obtained by fulfilling at least one criterion of each following section below.
*RTM treatment management services (CPT codes 98980 and 98981) can be furnished by therapists who are working in rehabilitation agencies and CORFs, but not when a patient is inpatient in a hospital or SNF.
You can use this code for both federal and commercial insurers.
Disclosure:
HappyNeuron has compiled this information for your convenience. These guidelines do not guarantee reimbursement and are subject to obsolescence as Medicare and other payers amend their policies. All content in this document is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. The information provided was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. We will do our best to stay up to date on the latest laws and regulations.
Each patient case is unique and may require a unique combination of healthcare provider and procedure. HappyNeuron recommends that each patient condition be independently considered in terms of applicable coding and reimbursement. It is the responsibility of the medical provider and or the medical provider’s staff to make the final decision about what constitutes an appropriate diagnostic code and to understand the coverage policies for the payers they commonly bill.
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