98976 CPT code covers supply of a device to collect and send data of respiratory conditions like asthma or chronic obstructive pulmonary disease.
This code is assigned against a 30-day service period and encourages patients to manage their respiratory health. The bluetooth enabled device used in patient treatment should be FDA approved. In addition, it should automatically record respiratory information periodically.
Besides offering top-quality patient care, assigning accurate code is crucial to relieve timely reimbursement. This comprehensive guide will explore 98976 rtm respiratory, remote therapeutic monitoring copd, 98976 reimbursement rate,98976 vs 98975.
Remote Therapeutic monitoring copd
98976 Code refers to remote therapeutic monitoring, where experts help providers manage his/her respiratory conditions. It starts with a supply of a device to a patient that sends data regularly. Healthcare providers can visit the portal and check the patient`s health status.
Providers bill this code once in a month against 16 days of monitoring.CMS introduced new codes to encourage remote patient monitoring and enable providers to get adequate payments against their services The code 98976 is only against the device supply, in case of other health-related services, 98980 or 98981 should be assigned.
How Does CPT Code 98976 Work in RTM?
Remote Therapeutic Monitoring (RTM) helps providers track how patients use their treatment at home. Instead of tracking body measurements like blood pressure, RTM focuses on whether patients follow their treatment and how well it works. CPT code 98976 covers the supply of a respiratory RTM device and the transmission of its data over a 30-day period.
Simple respiratory RTM workflow
- Device: The patient receives an eligible respiratory RTM device, such as a connected inhaler sensor or spirometer.
- Data collection: The device records treatment data and sends it to the provider.
- Provider review: The provider checks the data to see how the patient is doing.
- Therapy adherence: The data shows if the patient is using the treatment as instructed.
- Therapy response: The provider looks at whether the treatment is helping the patient.
- Digital therapeutic interventions: Tools like inhaler sensors collect treatment data and support patient care.
Which Patients Can Qualify for CPT Code 98976?
Patients may qualify for CPT code 98976 if they have a respiratory condition that requires Remote Therapeutic Monitoring (RTM) with an eligible medical device. Common conditions include:
- COPD: To monitor inhaler use and follow the treatment plan.
- Asthma: To track how regularly the patient uses prescribed therapy.
- Chronic respiratory diseases: For ongoing monitoring of long-term breathing conditions.
- Post-lung surgery patients: If the provider prescribes respiratory therapy and remote monitoring as part of recovery.
- Other respiratory conditions: Patients with other breathing disorders may also qualify when remote monitoring supports their treatment.
Eligibility depends on the patient’s condition, the treatment plan, and whether all RTM billing requirements are met. The provider must also document that the service is medically necessary.
Billing Requirements for CPT Code 98976
Device Requirements
To bill CPT code 98976, the patient must use an eligible medical device that supports 98976 RTM respiratory services. The device should collect therapy-related data and send it to the provider during the monitoring period. Common examples include connected inhaler sensors and spirometers.
The device must be part of the patient’s treatment plan. Simply giving a device to the patient does not qualify for billing. It should collect data that helps the provider track treatment use and make care decisions.
Minimum Monitoring Period
CPT 98976 covers the supply of the device and data transmission for a 30-day period. The code is reported once for each completed 30-day monitoring period when all billing requirements are met.
Providers should also follow the current RTM billing rules before submitting a claim. If the required monitoring period or other billing conditions are not met, the service should not be billed.
Documentation Requirements
Good documentation is required to support every claim. The medical record should clearly explain why remote monitoring was needed and how it supported the patient’s care.
Documentation should include:
- The patient’s respiratory diagnosis.
- The treatment plan.
- The eligible medical device used.
- The 30-day monitoring period.
- The therapy data received from the device.
- How the provider used the data to support patient care.
For example, a patient receiving remote therapeutic monitoring for COPD should have records that show the treatment plan, device data, and the provider’s review of that information.
Eligible Providers
Qualified healthcare providers who are allowed to report RTM services can bill CPT 98976. The provider must order the service, review the therapy data, and keep documentation that supports medical necessity.
The service should be part of the patient’s ongoing treatment and follow all applicable RTM billing requirements.
Can 98976 Be Billed Every Month?
Yes. CPT code 98976 may be billed once every 30 days when all billing requirements are met. The patient must continue to qualify for respiratory RTM, use the eligible device during the monitoring period, and have complete supporting documentation.
If any billing requirement is missing, the code should not be reported for that month. Information about the 98976 reimbursement rate is covered separately because payment amounts may vary by payer and year.
CPT 98976 Reimbursement
The 98976 reimbursement rate depends on the payer, the provider’s location, and current payment policies. There is no single payment amount that applies to every claim. Before billing CPT code 98976, providers should always check the latest fee schedule and payer guidelines.
CMS Medicare data shows that some providers reported substantial use of CPT 98976. For example, one internal medicine provider reported 2,717 services for 1,302 Medicare beneficiaries, with an average Medicare allowed amount of $48 and average Medicare payment of $39 per service.
How Reimbursement Works
CPT 98976 pays for the device supply and data transmission used in respiratory Remote Therapeutic Monitoring (RTM) during a 30-day period. Payment is available only when all billing requirements are met and the service is supported by complete documentation.
Medicare vs. Commercial Payers
Medicare follows its own payment rules and updates reimbursement rates through the annual fee schedule. Commercial insurance plans may use different payment methods, coverage rules, or contract rates. Because of these differences, the payment amount can vary between payers.
Geographic Variation
Medicare payment is not the same across every location. The provider’s geographic area can affect the final reimbursement amount. This adjustment helps reflect differences in local practice costs.
Why Reimbursement Differs
Several factors can change the payment for CPT 98976, including:
- The payer’s reimbursement policy.
- The provider’s location.
- Annual payment updates.
- Contract terms for commercial insurance.
- Whether all billing requirements are met.
Even when two providers bill the same code, they may not receive the same payment.
How RVUs Affect Payment
Medicare uses Relative Value Units (RVUs) to help calculate payment for many CPT codes. RVUs measure the value of a service based on factors such as provider work, practice expenses, and professional liability costs. Those values are then adjusted by location before the final reimbursement is calculated.
Always verify the current 98976 reimbursement rate before submitting a claim, as payment policies and fee schedules can change from year to year.
Conclusion
CPT code 98976 plays an important role in respiratory Remote Therapeutic Monitoring by covering the supply of an eligible medical device and its data transmission during a 30-day monitoring period. Correct billing depends on using a qualified device, meeting RTM requirements, and keeping complete documentation.
Providers should also review current payer policies because reimbursement and coverage may vary. Understanding these rules can help reduce billing errors and support accurate claim submission.
At MediRemote, we help healthcare providers stay up to date with medical billing guidelines, CPT coding changes, and RTM best practices. Our goal is to simplify complex billing topics so providers can improve compliance, streamline reimbursement, and focus more on delivering quality patient care.
FAQs
Can CPT code 98976 and 98975 be billed together?
No. CPT 98975 covers RTM service setup and patient education, while CPT 98976 covers respiratory device supply and data transmission. They report different services.
Does Medicare cover CPT code 98976?
Yes. Medicare covers CPT 98976 when all RTM billing requirements are met, including medical necessity, eligible device use, proper documentation, and payer guidelines.
What is the difference between 98976 vs 98975?
CPT 98975 reports RTM setup and patient education. CPT 98976 reports respiratory device supply and data transmission during a 30-day monitoring period.
What conditions commonly qualify for CPT 98976?
Common examples include COPD, asthma, and other chronic respiratory diseases that require remote therapeutic monitoring with an eligible medical device as part of treatment.
What affects the 98976 reimbursement rate?
The 98976 reimbursement rate depends on the payer, geographic location, annual fee schedule updates, RVUs, and whether all billing requirements are satisfied.
Is CPT 98976 used only for respiratory RTM?
Yes. 98976 RTM respiratory services apply to respiratory monitoring. Musculoskeletal RTM device supply is reported with a different CPT code.
