CPT 98975: A 2025 Billing Guide for Remote Monitoring
CPT 98975 represents the initial setup and kind of patient education needed to begin Remote Therapeutic Monitoring (RTM) services. As of 2025, this code, well, plays a pretty critical role in practices adapting to RTM digital care software workflows. Physicians use 98975, actually, to report time spent on configuring RTM devices and explaining stuff to patients.
With CMS kind of supporting virtual care infrastructure more aggressively, this code, as such, ensures that the often-overlooked non-face-to-face clinical work is still fairly reimbursed. Clinically, it helps keep care going, especially in specialties like orthopedics, respiratory therapy, or even pain management, where traditional RPM doesn’t quite fit.
CPT 98975 Medicare Billing Guidelines Explained
CPT code 98975 is reimbursable under Medicare, well, when certain conditions are properly met. It’s billed once per episode of care and includes:
- The initial RTM device setup
- Pretty basic but necessary patient education
- Expectations around data transmission
The episode has to last at least 16 days. Billing teams, to be fair, need to confirm that the device meets FDA guidelines and that there’s supporting clinical documentation. This makes sure reimbursement lines up with what was actually done.
Medicare Billing Workflow for CPT code 98975
| Step | Description |
|---|---|
| Device Setup | Patient receives and activates the remote monitoring device |
| Clinical Oversight | Provider monitors patient use and ensures correct data flow |
| 16-Day Data Rule | Patient must transmit data on at least 16 days in a 30-day period |
| Physician Documentation | Provider reviews and documents analysis of transmitted data |
| Billing | CPT 98977 is billed for supply and device data collection |
Remote Therapeutic Monitoring Setup Code: What to Know
As the go-to setup code for RTM, 98975 CPT code is, sort of, different from other RPM initial setup codes like 99453. It’s only used for RTM-eligible conditions, and yeah, it’s typically used alongside device supply codes like 98977 applied in therapy, orthopedics, or pulmonology.
The device must collect non-physiological data, like therapy adherence or pain levels. Setup work is performed by clinical staff or auxiliary personnel under general supervision. SmartCare360 helps keep track of this, by the way, with workflow logs and documentation that’s already embedded into the system.
98975 Patient Education Billing Requirements
Patient education is, actually, a pretty important part of getting paid for 98975. Physicians must ensure that staff walk patients through how the device works, how often they should use it, and what to do if something feels off.
Education must be documented, including time spent, method (like phone, video, or in-person), and who provided the instruction. Billing teams, to be fair, should also verify whether auxiliary staff are allowed to bill “incident to” under supervision.
Patient Education Billing vs Device Setup under CPT 98975
| Billing Component | Time Requirement | Billable? | Supporting Documentation |
|---|---|---|---|
| Patient Education | Typically 15–20 minutes | Yes | Education log, patient attestation |
| Device Setup | Single session setup | Yes | Device pairing log, training confirmation |
98975 CPT Code Documentation Requirements for Compliance
Compliance hinges on, well, clean and pretty detailed documentation. Providers need to show:
- RTM episode start date
- Confirmation of device setup and delivery
- Staff time logs for education
- Notes on how the patient was instructed (duration, method)
Auditors, yeah, they look for consistency between EHR entries and billing claims. SmartCare360 kind of helps with that by generating documentation templates that make the process smoother.
RTM Initial Device Setup Reimbursement: Key Insights
CPT code 98975 is reimbursed, usually, around $20–$25 nationally. It’s only billable once per episode, and stacking it with other setup codes, like 99453, is not allowed. Practices, to be honest, should double-check episode definitions before billing.
Over the past couple years, reimbursement trends show more adoption. Practices that fold RTM into bundled care models see fewer denials, probably because their workflows are more structured.
Reimbursement Trends for CPT 98975 (2023–2025)
RTM CPT Codes vs RPM Codes: Reimbursement Comparison
RTM vs RPM Billing Codes Comparison
| Code | Description | Use Case | Reimbursable Time | Average Rate |
|---|---|---|---|---|
| 98975 | RTM setup + education | Non-physiological data | Once per episode | ~$20–25 |
| 98976 | RTM device data transmission | MSK or resp. monitoring | 16 days/month | ~$55 |
| 99453 | RPM device setup | Physiological data | Once per episode | ~$19 |
| 99454 | RPM device data transmission | Vital signs monitoring | 16 days/month | ~$48 |
Future Trends: AI and Value-Based Care in RTM Billing
AI is, well, starting to make a real difference in how RTM data gets used. In 2025 and beyond, automated alerts from RTM devices may help catch issues earlier, which, sort of, saves downstream costs.
More payers are, in fact, looking at RTM outcomes inside value-based contracts. Clinics using SmartCare360 can kind of embed AI tools right into their workflows, which helps tie documentation directly to billing logic.
Common CPT 98975 Billing Errors and How to Avoid Them
Common issues? Billing 98975 more than once per episode, forgetting to log education time, or using devices that technically don’t qualify. Many denials, actually, happen because the setup wasn’t documented well enough.
Maybe consider regular audits. SmartCare360 helps here by flagging duplicate or invalid billing patterns and making sure device codes align with CMS policy.
FAQ's
What conditions qualify for CPT 98975 under RTM?
CPT 98975 supports RTM for musculoskeletal, respiratory, or therapy-related monitoring. It doesn’t include physiological data like blood pressure. Valid use cases include inhaler tracking, pain logging, or therapy compliance monitoring.
Can auxiliary staff perform services billed under 98975 CPT Code?
Yes, but only under general supervision. You’ll need to document time, staff credentials, and what educational services were provided. CMS requires these to meet “incident to” standards.
Is CPT 98975 billable with RPM setup codes like 99453?
Not really. CPT 98975 and 99453 can’t be billed together for the same episode. RTM covers non-physiological metrics, while RPM is more about things like heart rate or blood pressure.
How often can CPT code 98975 be billed per patient?
Only once per episode. Rebilling is possible only if a brand-new episode is clearly documented. Overuse or stacking could trigger payer review.
How does SmartCare360 support CPT 98975 billing workflows?
SmartCare360 tracks RTM setup steps like device configuration, time logs, and documentation. It helps clinics stay aligned with CMS rules and reduce rejections using built-in billing logic.
