Does Blue Cross Blue Shield cover RTM?

Why one Blue tells you nothing about another

The clearest proof is in our own register. Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of Illinois share a parent company (HCSC) and were recorded with opposite RTM positions. Idaho has two Blues, Blue Cross of Idaho and Regence, and they disagree too. California has two as well: Anthem Blue Cross and Blue Shield of California are separate companies.

Many rows below come from the AMA's commercial payer survey, last updated August 2023. They are labelled unverified and are a dated indication, not a current answer.

Every Blue plan we have looked at

"No policy found" is an honest answer, not a coverage decision. A plan we have not listed has not been researched. Search it in the lookup or ask us to look.

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.