Can two clinics using the same National Provider Identifier (NPI) both bill for RTM codes at the same time?
An article reviewing billing restrictions for RTM CPT codes. What partitioners should know before they get started.
Short answer: No.
Billing Restrictions for RTM CPT Codes
The Centers for Medicare & Medicaid Services (CMS) has set forth specific guidelines for billing RTM CPT codes to prevent double billing and ensure the appropriate use of healthcare resources. According to these guidelines, only one practitioner can bill CPT codes 98975, 98976, 98977, and 98978 during a 30-day or monthly period for a given patient.
This means that if a physician bills RTM services for a patient, another healthcare provider, such as a physical therapist, cannot bill RTM under the same National Provider Identifier (NPI) for the same patient within that time frame.
The Importance of Adhering to Billing Guidelines
Following the billing guidelines for RTM CPT codes is crucial for several reasons. First, it helps to ensure that healthcare providers deliver the most appropriate care to their patients, as it encourages the selection of the most suitable monitoring service based on the patient's needs.
Second, adhering to the guidelines prevents potential double billing, which could lead to inflated costs and unnecessary strain on the healthcare system. By limiting the billing of RTM services to one practitioner per patient per month, the CMS can better manage healthcare resources and maintain the financial sustainability of the system.
In conclusion, understanding and adhering to the billing restrictions for Remote Therapeutic Monitoring CPT codes is essential for healthcare providers. By complying with the guidelines set forth by the CMS, practitioners can avoid potential billing issues while ensuring that they deliver the most appropriate and cost-effective care to their patients. This approach ultimately benefits both healthcare providers and the patients they serve.
