CPT Code 98976: What Physicians Must Know for 2026 Reimbursement
To be fair, CPT code 98976 isn’t entirely new, but in 2026, it’s actually taking on more operational weight than before. Physicians who use remote therapeutic monitoring (RTM), especially for respiratory cases, will sort of need to reassess how this code integrates into evolving CMS billing expectations. So yes, while the code seems straightforward, it’s often misused, or just, you know, underleveraged among other Remote Therapeutic CPT codes.
This post breaks down what doctors really need to know, not just technically, but practically, before they submit claims under 98976 moving forward.
CPT Code 98976 Description and Why It Matters in 2026
CPT code 98976 refers to the use of an RTM device that, well, passively collects and transmits respiratory therapy data, usually over at least 16 days in a 30-day window. The goal? To sort of keep an eye on how a patient’s therapy adherence or response is playing out, remotely.
In 2026, though, it’s not just about monitoring. Actually, CMS wants to see tighter alignment between device use, EHR capture, billing compliance, and medical necessity. So yeah, clinics will probably need to do more than just connect a device and hope it qualifies.
Remote Therapeutic Monitoring CPT Code: Clinical Use Cases
RTM codes, and 98976 in particular, are really designed to fill the gaps RPM doesn’t cover. Think: behavioral patterns, therapy usage, and treatment adherence. This sort of expands the billing scope for chronic respiratory management, which is increasingly common.
CPT 98976 in Respiratory Monitoring and Chronic Conditions
For real-world examples: maybe you’re tracking how often a patient uses a nebulizer for COPD, or how regularly they’re using their asthma inhaler. In fact, 98976 works best in cases where monitoring therapy engagement is more meaningful than just watching vitals.
So, in post-COVID care or asthma plans, the device doesn’t just collect data, it shows patterns. That’s, frankly, more valuable from a treatment standpoint.
RTM Device Requirements for CPT Code 98976 Billing
To be billable, the device sort of needs to check a few specific boxes. And while that might sound obvious, in practice, it’s surprisingly easy to miss the mark.
RTM Device Criteria for CPT 98976 Billing
| Requirement | Description | Example Device Features |
|---|---|---|
| FDA Clearance | Must be cleared for respiratory therapy monitoring | Therapy-use monitoring approval |
| Automated Data Transfer | No manual uploads permitted | Real-time or passive sync |
| Daily Data Capture | ≥16 days needed per 30-day cycle | Calendar tracking, usage timestamps |
| Behavioral Insight | Non-physiological therapy adherence | Puff count, inhaler timing, logged doses |
You’ll kind of want to double-check that the device logs can actually be retrieved, or else your billing team will have a tough time justifying claims.
CPT Code 98976 Reimbursement Under Medicare in 2026
Medicare’s still on board with RTM billing in 2026, but, like, it’s definitely more stringent about the how. If anything, documentation gaps are more likely to trigger denials now than before.
Medicare Billing Requirements for CPT 98976
So, for billing to go through, the QHP must ensure a few things:
- That the patient, well, consents to the RTM program
- That the device data actually spans 16+ days in 30
- That you document interpretation or clinical use
- And yeah, the device must meet CMS RTM device standards
Documentation and Reporting Guidelines for Audit Readiness
To be honest, this is the section most practices kind of gloss over, and later regret. CMS auditors will want:
- A clear start and end date for each billing period
- Clinical notes that reference the RTM data explicitly
- A summary of therapeutic adjustment, if any
- And evidence that the data was, in fact, reviewed, not just stored
Even if the patient used the device, if there’s no documented interpretation? You’re likely to lose the reimbursement.
Understanding the Difference Between 98975, 98976, and 98977
You’d think this part would be straightforward, but, to be fair, the distinctions between these codes are often blurred in actual workflows. And that leads to billing confusion.
Key Differences Between RTM Codes
| Code | Description | Use Case | 2026 Reimbursement Notes |
|---|---|---|---|
| 98975 | RTM onboarding & education | Initial setup and instructions | Once per episode of care |
| 98976 | Respiratory therapy data | Asthma, COPD, post-COVID rehab | Needs 16+ days of data/month |
| 98977 | Musculoskeletal therapy data | Rehab, post-surgical recovery | Same structure as 98976 |
Preparing Your Practice for 2026 RTM Billing Changes
Well, 2026 isn’t that far off, and it’s going to bring more automation, more reviews, and maybe a bit less billing flexibility. Practices that don’t align workflows with device data will probably, you know, feel the pressure later.
AI-Driven Coding and RTM Reimbursement Optimization
SmartCare360, used as an operational layer, not a provider, helps with real-time checks and backend logic to catch things before submission. That sort of thing really matters when CMS systems begin auto-flagging missing thresholds or unsupported claims.
Adoption of AI in RTM Coding and Claims (2023–2026)
Operational Pitfalls and Risk Areas in CPT Code 98976 Billing
Physicians mean well, but billing compliance is, well, a different beast. And 98976 has some very specific tripwires.
Common Billing Errors and CMS Red Flags in RTM Claims
- Device didn’t transmit enough days of data
- You billed for RPM but used RTM criteria
- No link between the RTM data and clinical action
- Patient wasn’t informed about the service at all
Small misses can lead to, like, big reimbursement delays.
Best Practices to Improve RTM Reimbursement Rates
- Confirm the device qualifies before the first claim
- Don’t forget to document your interpretatio
- Build a short, repeatable EHR template for RTM visits
- Use SmartCare360’s tools to validate eligibility and log errors early
Final Checklist for 2026 RTM Billing Success
Not every platform is built with CPT 98981 in mind. A lot of tools still prioritize RPM (like 99457), and sort of tack on RTM features later.
To be compliant and audit-ready, practices should ask:
- Does it track 20+ minutes/month, per patient, automatically?
- Are real-time interactions timestamped and logged properly?
- Is the platform designed for RTM, not just repurposed RPM?
You also want something that fits, more or less seamlessly, into your existing workflow. If staff have to bounce between systems or manually enter time, the risk of denials, and burnout, goes up fast.
SmartCare360 RCM Flow: Validation Checkpoints
1. Device Setup
Patient is onboarded and device assigned.
2. Data Collection
Patient usage data starts logging daily.
3. Clinical Review
Staff or provider reviews patient metrics.
4. Documentation
Interactions, time, and findings are recorded.
5. Coding
Appropriate CPT codes assigned to services.
6. Claim Submission
Final claim is created and submitted to payer.
FAQ's
What is CPT 98976 used for in respiratory therapy?
It’s used to bill for monitoring of respiratory therapy adherence using a connected device. You’ll need 16+ days of data per month.
Is CPT Code 98976 reimbursed under Medicare in 2026?
Yes, assuming documentation supports it, the patient consented, and a qualified device was used for eligible conditions.
How does CPT 98976 differ from RPM codes like 99457?
To bill CPT 98981, providers must document at least 20 minutes of RTM treatment man99457 tracks physiologic data (e.g., heart rate); CPT 98976 captures therapy adherence patterns, like how often a patient uses their nebulizer.agement within a calendar month. There must also be at least one real-time (audio or video) interactive communication between the provider and patient, this proves clinical engagement and justifies the code under Medicare rules.
Can physical therapists bill CPT 98976?
Not usually. This code is for physicians and QHPs under current CMS rules. Therapists may use alternative RTM codes, depending on supervision.
Does SmartCare360 support CPT 98976 billing workflows?
Yes. SmartCare360 provides backend logic, workflow support, and compliance flags that help your staff avoid billing errors, without offering clinical care directly.
