Short answer for Highmark
Yes, with criteria.
Medically necessary with criteria. Physical therapists are explicitly named. But FDA-authorized technology is required.
What the document says
The single most consequential criterion in this register: 'All technology utilized has been authorized by the FDA, either through approval, clearance, or emergency use authorization.' A platform that is not FDA cleared would not meet it. Note the internal tension: the same policy defines RTM data as 'typically self-reported'. On the favorable side, the authorized provider list explicitly includes Physical Therapist (PT) and Occupational Therapist (OT) alongside MD, DO, NP, PA, CNM, CP, CSW, MHC, MFT and SLP. Treatment plan must be respiratory, musculoskeletal or cognitive. Initial authorization is 3 months, reauthorization in 3-month blocks requiring documented ongoing measurable improvement. Quantity limit: setup/supply/education once per 30-day period, max 6 per calendar year.
RTM codes the document addresses:
- 98975
- 98976
- 98977
- 98978
- 98980
- 98981
Limits worth knowing before you enroll
- Physical therapists are named in the authorized provider list, which not every Blue policy does.
- The treatment plan must be respiratory, musculoskeletal or cognitive.
- Initial authorization is 3 months, renewable in 3-month blocks with documented, ongoing, measurable improvement.
- Setup and supply are limited to once per 30 days, 6 per calendar year.
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.
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.