2025/2026 RTM CPT Codes: Key Changes, New Codes, and Compliance Rules
Welcome to the essential guide to RTM CPT codes. This resource helps providers like you get reimbursed for remote therapeutic monitoring. The codes is not brand new. However, they are quickly evolving. We will dive deep into the details of the 2025 RTM CPT codes, and even peer into the Proposed 2026 RTM Codes to help you stay ahead of the curve.
RTM is distinct because it tracks non-physiologic data. This includes musculoskeletal pain, medication adherence, and even inhaler usage. The primary goal is enhanced care continuity. RTM supports ongoing patient monitoring even when you are not physically with the patient. These RTM billing codes allow for several key services. These services include patient onboarding and education. They also include supplying therapy-specific devices. Finally, they cover active, ongoing monitoring time. Unlike RPM, RTM has greater flexibility in who can manage the service. Non-physician staff such as nurses or therapists can handle the day-to-day workflow. They must operate under your direct supervision. This flexibility is highly beneficial for busy practices.
Navigating Remote Therapeutic Monitoring (RTM) for 2025/2026
Remote therapeutic monitoring CPT codes are vital for modern healthcare. They help providers expand their services. Using them correctly is crucial for compliance. The guidelines change yearly through CMS updates, we will analyze the 2025 RTM CPT codes in detail. We will also explore the Proposed 2026 RTM Codes and potential policy shifts. Understanding these updates ensures your practice’s compliance. It also maximizes rtm codes reimbursement. This article provides clarity on complex rules. It helps you implement RTM confidently. It ensures a smooth and profitable billing process.
In-Depth Look at 2025 RTM CPT Codes
The 2025 RTM codes represent a comprehensive framework. They support a full episode of remote care. Each code has specific requirements and a distinct purpose. Understanding each one is key to accurate billing and to avoiding claim rejections.
CPT 98975: Onboarding and Patient Instruction
This is the foundational code. You bill this when beginning remote therapeutic monitoring CPT codes services. It covers initial setup and patient onboarding. It also includes comprehensive device training. This code is billable once per episode of care. An episode of care is a 30-day period. Your documentation must be thorough. It needs to include documented patient consent. You must show detailed device education. Finally, you must state the specific purpose of RTM. This code acts as the formal start. It initiates the RTM service in the patient’s record. Think of it as the crucial first step. Proper documentation here sets the stage for all subsequent billing. Without it, your entire claim could be jeopardized.
CPT 98976: Device for Respiratory System Monitoring
This code covers the provision of a connected device. This device must monitor the respiratory system. It applies to devices like smart inhalers. It also includes connected nebulizers. Any FDA-cleared device that logs usage qualifies. To bill this code, the device must be used for at least 16 days. This must occur within a 30-day period. The data must serve a specific clinical purpose. This purpose includes asthma control or COPD management. It is a key part of RTM billing. This code is essential for practices focused on pulmonary rehabilitation or chronic respiratory conditions. Documentation must confirm the device’s FDA clearance. You must also prove the device was used for the minimum duration.
CPT 98977: Device for Musculoskeletal System Monitoring
This code is used for orthopedic and rehabilitation conditions. The RTM devices might track range of motion. They could also monitor step count. Movement patterns are another example. You should use CPT 98977 for specific cases. These include tracking post-surgery recovery. This also applies when adjusting therapy based on movement data. It is also for patients enrolled in physical or occupational therapy. The device must be a digital solution. It needs to transmit data automatically. It should require minimal patient input for data transfer. This ensures data integrity. It also makes the process seamless for the patient.
CPT 98980: First 20 Minutes of Monitoring
This code covers the first 20 minutes of professional time. This time is spent on clinical decision-making. You must review the collected RTM data. Patient management is also a part of this. You must also make therapeutic decisions. Billable activities include reviewing device trends. They also include direct patient communication. Finally, they cover changes to the treatment plan. It is crucial to log the actual time spent. The activities must directly relate to a clinical purpose. This code is a core component of rtm billing. The time can be spent by the billing provider or clinical staff under supervision.
CPT 98981: Additional 20 Minutes of Monitoring
This is an add-on code. You use it for each additional 20-minute block. This is billed following the initial 98980. For example, if you spend 40 minutes, you would bill 98980 plus one unit of 98981. If you spend 60 minutes, you would add another 98981. You must document all communication clearly. This includes texts, calls, and data reviews. All activities must link to patient outcomes. This is a critical tip for RTM billing. It’s important to track this time diligently. Each increment must be justified by clinical work.
Key Differences: RTM vs. RPM in 2025
Understanding the distinction is vital. Remote patient monitoring CPT codes and rtm cpt codes 2025 are not interchangeable. Using the wrong set of codes can lead to immediate claim denials. The primary difference is the type of data.
RPM vs. RTM: Data and Staffing
- RPM focuses on physiologic data. This includes clinical vitals like blood pressure, heart rate, and weight. The devices are typically considered medical-grade. The oversight must come from a physician or other qualified healthcare professional.
- RTM focuses on non-physiologic data. This includes symptom tracking, therapy adherence, and behavioral data. The devices can be a wider range of FDA-cleared digital therapeutics. A broader range of clinical staff, including physical and occupational therapists, can manage RTM. This is a crucial distinction that offers greater flexibility.
Choosing the right code is essential. Use RTM for conditions related to therapy. Examples are physical therapy, asthma management, or behavioral health. Use RPM for chronic diseases. Examples are diabetes, hypertension, and heart failure. Payers scrutinize these distinctions. Using the wrong codes can lead to claim denials.
Detailed Comparison Table: RPM vs. RTM
Here is a detailed comparison. It helps clarify the differences.
| Feature | Remote Patient Monitoring (RPM) | Remote Therapeutic Monitoring (RTM) |
|---|---|---|
| Data Type | Physiologic Data (e.g., blood pressure, heart rate) | Non-Physiologic Data (e.g., therapy adherence, pain levels) |
| Billing Provider | Physicians, NPs, PAs | Physicians, NPs, PAs, Physical Therapists, Occupational Therapists, Speech-Language Pathologists |
A simple infographic could visually represent this table. It would use icons for each feature. A heart for RPM data and a person exercising for RTM data. This would improve scannability and comprehension.
Proposed 2026 RTM Codes and Future Outlook
The landscape of remote monitoring is dynamic. The Proposed 2026 RTM Codes may bring new changes. CMS reviews and updates codes annually. We anticipate potential changes to the 16-day rule. New codes may be introduced. These codes would cover shorter monitoring periods. This would benefit acute care cases. It would expand the use of RTM to more episodic care scenarios. We also expect further clarifications. These clarifications would be for behavioral health RTM. Providers should stay updated on CMS’s final rule. This is usually released in late fall. These updates will affect future rtm codes reimbursement.
A significant trend to watch is the potential for code consolidation. There has been discussion about merging the musculoskeletal and respiratory device codes. This would simplify billing for some providers. We also anticipate continued policy refinement regarding who can bill and under what circumstances. The goal is to create a more streamlined and efficient system.
Avoiding Code Overlap and Claim Rejections
Compliance is paramount. Preventing claim rejections is critical. Never bill both RTM and RPM for the same service. This applies to the same patient and condition. It also applies to the same calendar period. There are some exceptions. For example, a patient with both hypertension and COPD. You could bill RPM for their blood pressure. You could bill RTM for their inhaler usage. This requires “airtight” documentation. The rationale must be crystal-clear. Always prioritize accurate coding. This protects your practice from audits.
Best Practices for RTM Billing Compliance
- Documentation is King:
For CPT 98975, document patient consent, onboarding steps, and device training. For the monitoring codes, log all time spent and link it directly to clinical decisions and patient outcomes. - The 16-Day Rule:
The device must transmit data for at least 16 days in a 30-day period. This is a hard-and-fast rule. Failing to meet this minimum will result in claim denial. - Interactive Communication:
Codes 98980 and 98981 require at least one interactive communication with the patient per month. This must be a two-way, real-time conversation. Emails and portal messages do not count. - Medical Necessity:
All RTM services must be medically necessary. The CPT codes must be linked to a specific, justifying ICD-10 diagnosis. This is a fundamental principle of all medical billing. - Audit-Proof Your Practice:
Maintain a clear and organized record of all RTM activities. This includes device serial numbers, patient consent forms, time logs, and clinical notes. This diligence will be your best defense in a CMS audit.
RTM’s Role in Modern Care Delivery
Beyond just billing, RTM is transforming healthcare. It enables a more proactive, continuous model of care. For conditions like post-operative physical therapy, RTM devices can track a patient’s progress at home. This allows a therapist to intervene much faster. They can adjust a home exercise program based on real data, not just self-reported information from a weekly appointment.
Similarly, in respiratory care, a smart inhaler can track usage and environmental triggers. This data helps a physician identify patterns. They can then create a more personalized care plan. For behavioral health, RTM devices can track medication adherence and self-reported mood or symptom data. This provides a more holistic view of the patient’s condition. This kind of data-driven care leads to better patient outcomes and higher satisfaction.
Final Thoughts on RTM in 2025/2026
The future of healthcare is digital. Remote Therapeutic Monitoring is at the forefront of this transformation. By understanding the intricacies of the RTM billing codes, staying updated on the Proposed 2026 RTM Codes, and implementing best practices for compliance and documentation, your practice can not only improve patient outcomes but also secure a new and important revenue stream. This guide serves as a comprehensive resource to help you and I navigate this exciting and evolving landscape.
FAQ's
How do I bill for remote patient monitoring and RTM together?
You cannot bill RPM and RTM for the same condition. This applies in the same calendar period. You must choose the service that aligns best. You can bill them for different conditions. For example, RPM for congestive heart failure and RTM for a musculoskeletal condition. Documentation must clearly support both services. Always link each code to its specific diagnosis.
What devices qualify for RTM CPT codes in 2025?
Devices must be FDA-cleared. They should link to a specific therapy. They must transmit data automatically. They must be passive. Examples include smart inhalers, physical therapy monitors, and digital behavioral tools. Manual tracking apps do not qualify. The device’s primary function must be data transmission. It should not be a general-purpose consumer device.
Can RTM apply to behavioral or mental health?
Yes, RTM is a powerful tool. It is seeing significant growth. This is especially true in behavioral health. RTM codes are used for several purposes. They can track medication adherence. They also monitor symptoms. They help with therapy participation. This is very useful with digital CBT platforms. It offers a new way to engage patients between therapy sessions.
What is the RTM codes reimbursement rate?
Reimbursement rates vary. They depend on geographic location. They also depend on the specific code. You must consult the latest CMS fee schedule. This will give you the most accurate rates. Rates can change with annual updates. This is why staying informed is important. CMS often adjusts rates based on various factors. These factors include inflation and budget cuts.
How does RTM affect my practice’s bottom line?
Implementing a compliant RTM program can significantly boost practice revenue. On average, a single patient can generate an additional $160 per month. This figure includes the device supply and the monitoring time. Scaled across a large patient base, this represents a substantial new revenue stream. It is important to note, however, that this revenue is tied to patient engagement and documented staff time.
What is an "episode of care" for RTM?
An episode of care is a 30-day period. This period begins with the billing of CPT 98975. The subsequent device supply and monitoring codes are billed within this 30-day cycle. An RTM program can consist of multiple episodes. The end of one episode marks the beginning of the next, and you would again bill for the device and monitoring codes. CPT 98975, however, is billed only once per episode. This ensures a clean and compliant billing process.
