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RTM Billing Modifiers and Location Codes Explained

When billing Remote Therapeutic Monitoring (RTM) services, choosing the right Current Procedural Terminology (CPT) code is only half the battle. Correct modifier and location code use ensures your claims are processed quickly, paid in full, and remain compliant with payer rules.

This page covers three key RTM billing elements: the KX modifier, the CQ modifier, and Place of Service (POS) 11. You’ll learn when to apply each, the rules behind them, and the common mistakes that can cost clinics revenue.

Why Modifiers Matter in RTM Billing

Modifiers give payers important context about how a service was provided. In RTM, they can indicate:

  • Whether the patient has reached or is close to the therapy cap (KX modifier)

  • If a physical therapist assistant (PTA) furnished more than 10% of the service (CQ modifier)

  • The primary location where the service was delivered (POS 11)

Even with complete documentation, missing or incorrect modifiers can cause denials or delays.

KX Modifier — Therapy Cap Exception

Purpose

The KX modifier signals that services remain medically necessary even after a patient reaches or nears the therapy cap.

When to use in RTM

  • Patient is at or approaching the therapy cap

  • Medical necessity is documented

  • Service is covered under therapy services, including RTM codes 98975, 98977, 98980, and 98981

Example

A post-operative knee replacement patient continues to need RTM monitoring after hitting the therapy cap. Adding KX with proper documentation supports payment.

CQ Modifier — PTA Services

Purpose

The CQ modifier indicates that a PTA provided more than 10% of a billed service under the supervision of a physical therapist.

When to use in RTM

  • Required for CPT 98975 if a PTA delivers more than 10% of the onboarding and education

  • Required for CPT 98980 and 98981 if a PTA performs more than 10% of the treatment management time

  • Not required for CPT 98977 regardless of provider type

Example

A PTA performs most of the initial RTM setup session. CPT 98975 must include the CQ modifier to comply with CMS guidelines.

POS 11 — Office Location

Purpose

POS 11 identifies the provider’s office as the place where the RTM service was primarily delivered.

When to use in RTM

  • The provider’s office is the main point of service for RTM

  • Device issuance or patient training occurred in the office

  • The payer requires a location code for claim processing

Common RTM Modifier Mistakes to Avoid

  • Leaving off the KX modifier when the therapy cap has been reached

  • Applying CQ to CPT 98977 when not required

  • Using the wrong POS code for hybrid or telehealth programs

  • Failing to document the reason for using a modifier

How Orva Helps Clinics Get It Right

Orva’s RTM platform automatically applies modifier logic to billing reports. Built-in alerts flag when KX or CQ is required and assign the correct POS code. This automation helps your clinic avoid costly errors, reduce denials, and get paid faster.

Take the Next Step

Correct RTM billing starts with knowing the rules but success comes from applying them consistently. Orva can help your clinic track modifier requirements, organize documentation, and streamline claims.

Schedule a demo to see how we make RTM billing compliance effortless.