Short answer for Aetna
No published policy found.
No RTM determination exists. The bulletin often cited is an RPM policy.
What the document says
CPB 1093's stated scope is 'remote physiologic monitoring (RPM) services'. It contains exactly two code sections: 'CPT codes covered if selection criteria are met' (99453, 99454, 99457, 99458, all RPM) and 'Other CPT codes related to the CPB' (the RTM codes). There is NO 'codes not covered' section, so claims that Aetna lists RTM as not covered are misreadings of the related-codes list. No separate Aetna RTM bulletin was located. For context, Aetna's RPM policy covers only heart failure, hypertension and diabetes and expressly excludes 'data collected manually by the patient and not automatically transmitted'.
Codes addressed: None. RTM codes appear only under 'Other CPT codes related to the CPB'.
Why Aetna gets misreported
Search this question and you will find summaries saying Aetna lists RTM as not covered, and others saying it covers it. Neither traces to a document. CPB 1093 has no "codes not covered" section at all. The RTM codes sit in a reference list, which is not a coverage decision either way.
So for an Aetna patient, the answer has to come from the plan. Call, ask about the specific codes by number, and say "remote therapeutic monitoring," because an RPM answer is not an RTM answer.
Check the plan, not just the carrier
About 67% of covered workers are in self-funded employer plans. The employer carries the risk, the carrier only administers it, and the employer's plan document governs. It can differ from the carrier's published policy. Cigna says so in its own instructions for use:
"In the event of a conflict, a customer's benefit plan document always supersedes the information in the Coverage Policies."
So a carrier policy narrows the question. It does not answer it for one patient. Call, name the codes, and write the answer down.
Other payers
How to use this page
This is a summary of a published payer document. It is not coverage advice and it cannot tell you whether one patient's claim will pay. The line of business, the employer's plan document and the patient's eligibility all sit between a policy and a payment. Our coverage guide walks through how to verify for a specific patient, and how to bill RTM covers the rest of the claim.
Policies change, usually in January. If you have a newer document or a remittance that contradicts this page, send it to contact@rehabityhealth.com and we will update the page.
Rehabity builds home exercise and remote therapeutic monitoring software for outpatient physical therapy clinics. We researched payer policy because we needed the answer ourselves. If you want to see what we build, read about the therapist side or join the waitlist.