RPM, RTM, CCM, PCM – Which Remote Care Program is Right for Your Patients?

The pandemic didn’t create remote care, but it has greatly accelerated the adoption of telehealth and remote care. The Centers for Medicare and Medicaid Services (CMS) continues to provide new reimbursement options for remote care services. And commercial payers are following their lead. Trends are pushing in the same direction – more healthcare delivered at home with the potential for $250 billion – or 20 percent of all total outpatient, office and home health to be delivered virtually.

Patients’ habits and expectations about remote care are also changing. Studies show, 25 percent of people would switch providers for better remote care options. Offering high-quality remote care programs is no longer a nice-to-have. They are a must-have for practices to stay competitive.

Remote Patient Care Program Options

So, with all of these different remote programs available, how do you know which one(s) are right for your patients? Let’s start with the acronyms:

RPM – Remote Patient Monitoring
RTM – Remote Therapeutic Monitoring
CCM – Chronic Care Management
PCM – Principal Care Management

RPM and RTM services are closely related. These monitoring services allow providers to remotely review and respond to their patients’ data collected from an FDA-defined device, such as blood pressure readings or medication adherence. One of the primary differences between RPM and RTM is the type of patient data collected from the associated devices being supplied for monitoring the data. Providers should enroll a patient in either RPM or RTM depending on their clinical needs and condition(s).

PCM and CCM are also closely related care management services for treating complex conditions.. Patients may qualify for one or the other based on the number of and severity of their diagnosed chronic conditions.

RPM/RTM can be a complement to CCM/PCM. RPM/RTM services include collecting and monitoring specific patient data. This data can be a great asset in providing care for patients with complex conditions that are part of a CCM or PCM program.

What are the Differences Between these Remote Care Programs?

	RPM	RTM	CCM	PCM
Objective	Monitoring of specific physiological parameters between office visits	Monitoring of specific therapeutic or non-physiological (including self-reported data), parameters between office visits	Chronic care management and coordination for patients with two or more complex conditions between regular office visits	Chronic care management and coordination for patients with one complex condition between regular office visits
Device and Reading Requirements	Requires use of FDA-defined device with a minimum 16 of days of readings per 30 days	Requires use of FDA-defined device with a minimum 16 of days of readings per 30 days	None	None
Diagnosis Requirement	No specific diagnosis requirement but RPM must be medically necessary	No specific diagnosis requirement but RTM must be medically necessary	Multiple chronic conditions (2+) lasting 12+ months	Single high-risk disease lasting 3+ months
Ordered by:	Physician or Qualified Health Care Professional (QHCP), who can bill for E/M services	Physician or Qualified Health Care Professional (QHCP), who can bill general medicine codes, including PTs, OTs, dieticians, psychologists.	Physician or Qualified Health Care Professional (QHCP)	Physician or Qualified Health Care Professional (QHCP)
Clinical Care Team Requirement	Requires minimum of 20 minutes by clinical staff per month	Requires minimum of 20 minutes by clinical staff per month	Requires minimum of 20 minutes by clinical staff per month Or Requires minimum of 30 minutes personally by the physician or QHCP	Requires minimum of 30 minutes by clinical staff, physician or QHCPper month
Monitoring Provided Incident to the Billing Practitioner	QHCP or clinical staff, including nurses under the general supervision of the billing practitioner	QHCP or clinical staff under the direct supervision of the billing practitioner	QHCP or clinical staff under the general supervision of the billing practitioner	QHCP or clinical staff under the general supervision of the billing practitioner
CPT® Codes	CPT® Codes 99453/99454/99457/ 99458	CPT® Codes 98975/98976/98977/ 98980/98981	CPT® Codes 99490/99491/99439/99437	CPT® Codes 99424/99425/ 99426/99427

Can I Bill for Multiple Remote Programs for the Same Patient?

A patient can be eligible for both a monitoring program (either RPM or RTM) and a chronic care management program (either CCM or PCM). However, the same minutes spent providing care cannot apply to both. The time requirements for each code must be met separately and no time can be double-counted.

Which Clinicians Qualify as “Clinical Staff”?

The type of personnel that qualifies as “clinical staff” for any of these programs will vary by state law and providers should look at the scope of practice laws in the patient’s state to determine who can provide care. CCM and PCM patients often have more complex needs that require care from providers with a higher-level education and scope of practice than RPM and RTM services.

Still Have Questions? Ready to Learn More?

For more details, download our complete Optimize Health 2022 RPM Billing and Coding Guide (includes CCM and PCM codes) and the Optimize Health 2022 Remote Therapeutic Monitoring (RTM) Billing and Coding Guide. Or set up a time to talk with one of our RPM experts. We are happy to answer billing questions and even help you conduct a financial analysis to determine which of these remote programs may be right for your practice.