From 2023, eligible mental health care professionals can generate extra revenue by monitoring client therapy adherence and response through the newly introduced CPT code for Cognitive Behavioral Therapy Remote Therapeutic Monitoring (RTM) and relevant existing codes.

Our CopingCard Provider Platform and Mobile App are perfectly equipped to enable your practice to utilize these new CPT codes to generate additional income.

On November 1, 2022, the US Centers for Medicare & Medicaid Services (CMS) unveiled the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS) (the Final Rule). The rule includes a new CPT code - 98978 (effective from January 1, 2023) for Remote Therapeutic Monitoring (e.g., therapy adherence, therapy response) for Cognitive Behavioral Therapy.

CMS Motivation

Therapy adherence and completion of home assignments are critical to improving mental health therapy outcomes. Remote Therapeutic Monitoring offers providers the visibility necessary to intervene when needed, enhancing patient engagement and subsequently improving patient outcomes. This leads to fewer hospitalizations and reduced medical costs, which is beneficial for health insurance companies.

Overview of the Codes

Four codes relevant to RTM and billable by mental health clinicians are available.

98975 covers the initial setup/education on the use of monitoring software, and is billable once per client with an estimated reimbursement of ~$19.

98978 covers remote therapeutic monitoring (e.g., therapy adherence, therapy response), billable monthly with an estimated reimbursement of ~$55.

98980 and 98981 cover remote therapeutic monitoring treatment management services, requiring both monitoring of customer engagement and an interactive communication (phone or telehealth call). 98980 is for the first 20 minutes with an estimated reimbursement of ~$50, while 98981 is for each additional 20 minutes with an estimated reimbursement of ~$40.

Requirements for RTM Claims

Each of the codes has specific requirements, but fundamental is the ability to gather data (at least 16 days out of a 30-day reporting period) on therapy adherence. This can be achieved both programmatically and through manual client input. Software as a medical device solution is necessary to collect the data required to issue claims for RTM-related CPT codes.

How CopingCard Platform and Client App make billing for RTM possible

CopingCard provides all the necessary components for collecting data and supporting evidence to issue claims with CPT codes for RTM.

Our solution includes a Mobile App for clients with evidence-based psychotherapy tools and tracking of how clients use the tools and techniques relevant to their therapy. The Provider Platform gives visibility into client tool usage, aggregates client usage statistics, and records time spent by therapists monitoring client activity outside of sessions.

This makes it easy to monitor client therapy adherence, intervene quickly when needed, determine if enough data has been collected to submit claims, and obtain the necessary supporting documentation (logs) of client and therapist activities.

Video of CopingCard functionality that enables RTM billing

Detailed Information on Codes

98975 - covers initial set-up and patient education on equipment use for remote therapeutic monitoring, such as musculoskeletal system status, respiratory system status, medication adherence, and medication response. Report once after client onboarding when 16 days or more of data is collected. Estimated Reimbursement: ~$19

98978 - covers remote therapeutic monitoring (e.g., therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days). This code represents supplying one or more devices for remote therapeutic monitoring for cognitive behavioral therapy. This code is reported once per 30 days and includes scheduled recording and/or programmed alert transmission. Report once per 30 days for monitoring of 16 days or more. Estimated Reimbursement: ~$55

98980 - covers 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. Estimated Reimbursement: ~$50

98981 - covers remote therapeutic monitoring treatment management services, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month, each additional 20 minutes. (List separately in addition to code for primary procedure.) Estimated Reimbursement: ~$40

Conclusion & Call to Action

While more health plans may start reimbursing RTM CPT codes in the future, currently Medicare and Medicaid can reimburse for Remote Therapeutics Monitoring, allowing for additional revenue of around $100-150 per qualified client per month.

An additional important development is the fact that on December 23, 2022, Congress passed the Mental Health Access Improvement Act (S. 828/H.R. 432). With this Act, Marriage and Family Therapists and Mental Health Counselors (Licensed Professional Counselors) will be eligible to become Medicare Part B Providers in 2024, and hence also eligible for Remote Therapeutics Monitoring claims. https://www.nbcc.org/govtaffairs/medicarefaq

Whether you're already qualified to bill for RTM or are interested in other benefits of the CopingCard platform for practice owners, including AI-assisted Progress Notes generation in 1-2 minutes instead of the typical 10-15, feel free to create a free account using this link: CopingCard Platform for Mental Health Practices or book a Live Demo at a time that works for you.