Short answer for Blue Cross of Idaho
Yes, with criteria.
Reimbursable with criteria. But it excludes manual logs and non-FDA-compliant software.
What the document says
The second payer in this register with a technology requirement, and the more pointed of the two. Reimbursable when 'the member requires monitoring of therapeutic adherence or therapeutic response' and 'data is generated by a medical device or approved digital therapeutic platform'. It explicitly EXCLUDES monitoring via 'phone calls, texting, or manual logs' and excludes non-FDA-compliant software. Whether a structured patient-reported app counts as a 'manual log' or as an 'approved digital therapeutic platform' is exactly the ambiguity a clinic should resolve with the plan before billing. Also note: RTM device-supply codes for different durations cannot be billed together in the same 30-day period for the same system, and 98979 cannot be billed with 98980 in the same calendar month.
RTM codes the document addresses:
- 98975
- 98976
- 98977
- 98978
- 98979
- 98980
- 98981
- 98984
- 98985
- 98986
The technology requirement
Some payers attach a requirement to the technology itself, on top of the clinical criteria. It can defeat a claim that meets every clinical criterion. "Meets the FDA definition of a device" is not the same as "FDA cleared." The CPT code descriptors ask for the first. A payer can ask for more, and this one does.
What to do: ask the plan in writing whether your platform satisfies the criterion before you bill, and ask your vendor what its FDA status actually is. For the record, since we build one of these: Rehabity is not an FDA-cleared device. We would rather say so on our own page than have you find out in a denial. More on this in the coverage guide.
Idaho's wording is the more pointed of the two payers with this kind of criterion: it excludes "manual logs." Whether a structured patient-reported app is a "manual log" or an "approved digital therapeutic platform" is exactly the question to settle with the plan first. Idaho also has a second Blue, Regence, which the AMA's 2023 survey recorded as not covering most RTM codes.
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.