Understanding the Reimbursement of Remote Therapy Monitoring (RTM) Services: Medicare, Private Payers and Billing Codes

Remote Therapy Monitoring (RTM) is a growing trend in telehealth services, providing mental health care to patients who cannot access traditional in-person therapy. This article will cover the reimbursement of RTM services by private insurance, Medicare, and private payers, as well as the billing codes used by the Centers for Medicare and Medicaid Services (CMS).

Who Pays for RTM Services?

Private insurance and Medicare are the main payers for RTM services, but the amount of coverage will depend on the patient’s individual insurance plan. Private insurance companies, such as United Healthcare, Aetna, and Cigna, may offer full or partial reimbursement for RTM services, but not all insurance providers will offer this coverage. It is important to check with your insurance company for their specific coverage and reimbursement rates.

CMS Reimbursement for RTM Services

CMS covers RTM services under its telehealth services provisions and reimburses them at regional rates. CMS uses specific billing codes, such as HCPCS codes 99457, 99458, and 99457, to reimburse RTM services, but it is recommended to check with CMS for updates on the codes being used.

Reimbursement Rates from Private Payers

Private payers may also reimburse RTM services, and the specific coverage will vary based on the patient’s insurance plan. It is important to check with your insurance company for their specific coverage and reimbursement rates.

Anticipated Reimbursement Rates for RTM Services

The reimbursement rate for RTM services is typically around 120% of the cost of traditional in-person therapy services. For example, a provider may charge a $20 one-time set up fee, $60 per patient per month to Noble Health, $115 per patient per month to the provider, and a $20 co-pay (potentially) for RTM services. These rates are subject to change, so it is important to check with the payer for their specific reimbursement rates.

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