Short answer for Cigna
No.
Not covered. All ten RTM codes excluded for any indication.
What the document says
Verbatim: 'Remote Therapeutic Monitoring (RTM) (CPT codes 98975, 98976, 98977, 98978, 98979, 98980, 98981, 98984, 98985, 98986) is not covered or reimbursable for ANY indication.' All ten codes also appear in the policy's 'Not Covered or Reimbursable' CPT table. This is a categorical exclusion, not a criteria-based restriction.
RTM codes the document addresses:
- 98975
- 98976
- 98977
- 98978
- 98979
- 98980
- 98981
- 98984
- 98985
- 98986
What that means in practice
Cigna's own instructions say the member's benefit plan document supersedes the coverage policy. For a fully insured Cigna plan, expect the exclusion to hold. For a self-funded employer plan that Cigna only administers, the employer's document governs, and it is the only thing that can say otherwise. Ask before you enroll a Cigna patient, and name all the codes.
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.