Rules, Reimbursement, and How to Make It Work for Your Clinic

Remote Therapeutic Monitoring (RTM) has evolved from a niche concept into a widely adopted service across physical therapy and orthopedic practices. In 2025, clearer policies from the Centers for Medicare & Medicaid Services (CMS) and broader adoption by commercial payers have made RTM a reliable billing pathway and a meaningful tool for improving patient outcomes.

Orva is a software platform purpose-built for remote care and home exercise program management. It gives clinics everything needed to implement RTM effectively—without burdening staff or complicating workflows. This guide outlines the latest rules, reimbursement strategies, and the operational best practices that will help your clinic succeed with RTM now and in the year ahead.

Understanding RTM CPT Codes and Billing Cycles

RTM billing relies on four primary Current Procedural Terminology (CPT) codes:

• 98975 – Billed once per episode for patient onboarding and initial setup. Requires at least 16 days of monitored activity in a 30-day period.

• 98977 – Billed every 30 days for the supply of RTM technology (for musculoskeletal use). Also requires 16 days of device use.

• 98980 – Billed monthly for the first 20 minutes of clinical RTM management. Must include at least one interactive communication with the patient or caregiver.

• 98981 – Add-on for each additional 20 minutes of clinical RTM management in the same month.

These codes are not tied to in-person visits. They do not count against visit caps or insurance authorization limits. Because RTM is classified as a “sometimes therapy” service, it typically does not require copays or SOAP notes. Orva tracks all time and usage thresholds automatically, reducing the burden on staff.

Documentation and Billing Compliance

Even though SOAP notes are not required for RTM billing, each claim must still reflect appropriate clinical oversight. Providers should include:

• A summary of what patient data was reviewed

• Any resulting changes to the plan of care

• A record of communication with the patient

• Precise time tracking for time-based codes

Orva’s clinician dashboard handles all of this seamlessly. It logs activity, compiles billing-ready summaries, and supports compliant documentation with minimal effort from the care team.

Only One RTM Provider May Bill per Patient

Only one clinic or provider can bill RTM codes for a given patient at a time. This applies to all four RTM codes. If two clinics submit overlapping claims, only the first claim processed will be reimbursed. The second will be denied.

It’s important to verify during intake whether the patient is already enrolled in another RTM program. Orva supports this process by standardizing intake messaging and internal workflows.

Device and Software Requirements

RTM codes can only be billed when the platform used qualifies as a medical device. Consumer health apps and fitness trackers do not meet CMS criteria.

Orva is classified as a medical device, making it fully eligible for RTM billing. It captures daily adherence, logs activity automatically, and produces audit-ready documentation. These built-in features reduce administrative work and help ensure compliance.

Avoiding Claim Denials

RTM billing is most successful when clinics follow strict timing protocols:

• 98975 and 98977: Submit only after 16 days of device use within a 30-day period.

• 98980 and 98981: Submit only after the end of the calendar month and after an interactive communication has occurred.

Submitting RTM claims too early—or without meeting all conditions—often results in denials. Orva allows clinics to schedule standardized submission dates (e.g., the first Saturday of each month) to avoid duplicate claims and simplify operations.

Reimbursement Amounts in 2025

National Medicare averages for RTM reimbursement are:

• 98975: ~$20

• 98977: ~$43

• 98980: ~$50

• 98981: ~$39 (each additional 20 minutes)

Many commercial insurers now cover RTM, but policies vary by state and payer. Before enrolling patients, especially those with private insurance, contact the payer to confirm:

• RTM eligibility

• Reimbursement amounts

• Any documentation or preauthorization requirements

Medicare Advantage plans usually follow CMS policy but may ask for upfront documentation before processing claims.

How to Handle Audit Requests

While uncommon, audit requests may occur—especially from Medicare Advantage plans. Strong documentation makes these easy to navigate. Best practices include:

• A signed plan of care supporting the use of RTM

• A detailed monthly summary showing device use, engagement, and time spent

• Notes from all patient communications, including dates and outcomes

Orva’s audit-ready reports and automated logs make responding to these requests simple.

Working with Physical Therapist Assistants

There is no reimbursement reduction for CPT codes 98975 and 98977 if a Physical Therapist Assistant (PTA) is involved.

For time-based codes 98980 and 98981, if the PTA delivers most of the service, a CQ modifier must be applied, and Medicare will reduce payment by 15 percent. Accurately logging who delivered the service is essential. Orva simplifies this by tracking provider roles within each patient record.

Best Practices for RTM Success with Orva

• Assign one lead RTM provider per patient

• Use Orva’s automatic time tracking and engagement monitoring

• Review patient activity at least weekly to prevent drop-off

• Rely on Orva’s built-in summaries to support billing and audits

• Submit claims on a consistent monthly schedule to reduce denials

What to Expect in 2026

Policy changes expected in 2026 will make RTM more accessible and flexible:

• New CPT codes will allow billing with fewer than 16 days of device use

• Additional codes will support 10–19 minutes of management time

• More commercial payers are expected to formalize RTM policies

Orva is actively preparing for these updates to ensure clinics can adapt quickly and continue maximizing RTM revenue.

Conclusion

Remote Therapeutic Monitoring is no longer experimental—it’s a core part of outpatient care in 2025. With the right tools and workflow, clinics can increase adherence, support better outcomes, and unlock new reimbursement streams. Orva was built specifically for this moment. It delivers a simple, compliant, and intuitive RTM experience for both patients and staff. As policies evolve, clinics that invest now will be best positioned for continued growth in 2026 and beyond.