Clear answers on RTM billing, workflow, and the codes clinics actually use

RTM is a way for clinics to monitor what happens between visits, not just during them. In orthopedic and PT settings, that usually means tracking whether patients are following their home program, how they are responding, and whether a clinician is actively managing care outside the clinic.

Orva supports 98975, 98985, 98977, 98979, 98980, and 98981. That covers the core musculoskeletal RTM workflow from patient set-up through device-supply qualification and monthly treatment management.

The best RTM candidates are patients who have a meaningful home program, need accountability between visits, and benefit from active follow-up. That often includes post-op patients, patients with mobility or pain-related limitations, and patients whose progress depends on consistent work outside the clinic.

98975 covers the initial set-up and patient education required to get RTM started. In practice, that usually means the patient is enrolled, given access, and taught how to use the monitoring tool as part of the episode.

Both are musculoskeletal device-supply codes. The difference is the number of qualifying days in the 30-day period. 98985 is the lower threshold for 2 to 15 days. 98977 is the higher threshold for 16 to 30 days.

Bill 98985 when the patient has enough qualifying activity to meet the lower device-supply threshold, but not enough to reach the higher one. Bill 98977 when the patient reaches the 16 to 30 day threshold in that same 30-day period.

Both are RTM treatment management codes tied to clinician time in a calendar month and at least one real-time interactive communication with the patient or caregiver. The key difference is the threshold. 98979 is the first 10 minutes. 98980 is the first 20 minutes.

98981 is the add-on code for each additional 20 minutes of qualifying RTM treatment management time in the same calendar month after the appropriate base management threshold has been met.

The time should reflect medically necessary management of the patient’s therapy plan. That can include reviewing adherence and response, deciding whether care needs to change, updating the home program, communicating with the patient or caregiver, and documenting the clinical decisions that follow.

Yes. The treatment management codes require at least one real-time interactive communication with the patient or caregiver during the calendar month. Clinics should also document when that communication occurred and how it relates to care management.

In the appropriate setting and under the proper therapy plan of care, these codes can be furnished as therapy services. Clinics still need to follow payer rules, apply the appropriate therapy modifiers, and make sure the services are being documented the right way for the setting they bill under.

• For 98975, document set-up and patient education.
• For 98985 and 98977, document the qualifying device-supply days in the 30-day period.
• For 98979, 98980, and 98981, document total time, the management work performed, and the required real-time interactive communication.

The strongest files make it easy to see what happened, when it happened, and why it mattered clinically.

RTM generally works best when it begins early in the episode, once the patient has a clear plan and a real reason to engage between visits. That gives the clinic enough time to drive adherence, monitor response, and capture the activity needed for compliant billing.

• Enrolling patients without a real follow-through process
• Missing the difference between the lower and higher device-supply thresholds
• Logging time inconsistently or too late
• Forgetting to document the real-time interactive communication
• Assuming every payer handles RTM the same way

Denials usually come from one of three places: the threshold was not actually met, the documentation does not clearly support the billed code, or the payer has its own policy logic that the clinic did not account for ahead of time.

Orva gives clinics visibility into patient activity so it is easier to see whether an episode is tracking toward the lower device-supply threshold or the higher one. That helps teams follow up earlier instead of discovering too late that a patient fell short.

Orva helps organize the monthly management workflow by making patient activity easier to review, flagging who needs attention, and supporting cleaner tracking of the work clinicians are already doing between visits.

The biggest compliance advantage is clarity. Clinics can see who is active, who is falling behind, and which episodes are worth reviewing for billing. That reduces guesswork, helps keep documentation tighter, and makes the process easier to manage month after month.

Most clinics do not need a complicated rollout. The best implementations start narrow, use a clear patient-selection process, and make it obvious who on the team is responsible for onboarding, follow-up, and billing review.