A glitch that was causing some Medicare Administrative Contractors, known as MACs, to erroneously deny two remote therapeutic monitoring codes as non-covered services is being corrected. In the meantime, the U.S. Centers for Medicare & Medicaid Services is advising providers who received denials for the codes to resubmit their claims.
The correction came about thanks in part to APTA's outreach to MACs.
The two CPT codes in question — 98980 and 98981 — were routinely being denied when submitted on a UB-04 while other RTM-related codes were accepted. The problem began in January 2023, and only affected those providers billing on the UB-04. APTA made CMS aware of the problem early in the year.
Recently, CMS acknowledged that the denials were made in error using reason code W7072, "service not billable to this fiscal intermediary," and that it will be correcting the issue in July when it releases code edit updates. Until then, the agency says it's bypassing W7072 for the two codes and urges facilities who received denials to resubmit claims.
Want to learn more about the use of RTM in PT practice? Check out APTA's updated practice advisory on the topic.