Short answer for BCBS of Michigan
Yes.
'Established' when criteria are met. Self-reported data explicitly accepted.
What the document says
Requires a written order from a physician or qualified practitioner specifying the medical condition and the length of time for RTM, up to 90 days. 'Data may be self-reported by the individual or may be electronically captured by a device.' Also: 'The use of a device is not required. If a platform is able to track data from an individual (eg, software, a wearable, self-reported information), remote therapeutic monitoring is achieved.' RTM 'is not intended to be an ongoing modality; it is intended to monitor a patient's response to a plan of care, until goals are reached.' The RTM device itself, including apps and software, is generally NOT separately covered. CAUTION: the retrieved document lists its own Next Review Date as 4th Qtr 2023, so it may have been superseded. Re-verify before relying on it.
RTM codes the document addresses:
- 98975
- 98976
- 98977
- 98980
- 98981
The friendliest wording we found on patient-reported data
"The use of a device is not required. If a platform is able to track data from an individual (eg, software, a wearable, self-reported information), remote therapeutic monitoring is achieved." Compare Highmark and Blue Cross of Idaho, which attach FDA technology requirements.
Before you rely on it: the document lists its own next review as the fourth quarter of 2023, so a newer version may exist. Ask BCBSM which version is current.
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.