Remote therapeutic monitoring and what RTM pays a PT clinic

Medicare began paying physical therapists for remote therapeutic monitoring in January 2022. In 2024, the most recent year in CMS’s claims file for physicians and other practitioners, 573 physical therapists in private practice billed 98980, the treatment management code that carries the largest share of RTM’s money. That year, 77,901 physical therapists in private practice billed Medicare at all.

That file publishes no row covering fewer than 11 patients, so read every count in it as a floor. The trend inside it is steep and the base is tiny: 111 PTs in 2022, 297 in 2023, 573 in 2024, and roughly $5.1 million in RTM allowed amounts across the whole profession in fee-for-service Medicare. CMS had expected more. Its CY 2022 fee schedule said “the primary billers of RTM codes are projected to be physiatrists, NPs, and physical therapists.”

That is not a profession missing an opportunity. It is one pricing it. Here is the same arithmetic.

What does remote therapeutic monitoring pay a physical therapy practice?

About $105 a month for a musculoskeletal patient at the national rate, and only in a month where somebody does the full twenty minutes.

CPT’s RTM family runs to ten codes. Eight of them are on Medicare’s therapy code list, which is the list that matters to a PT. The amounts below are CY 2026 national, non-facility: total RVUs times the $33.4009 conversion factor in CMS’s July 2026 relative value file. Your locality moves every one of them.

Three of those arrived in 2026, and they are not extra money. CMS confirmed the short-window and long-window codes “are not additive and are not a base and add-on code structure”: one device code per 30 days, one management code per month. Notice 98985 pays what 98977 pays, so six days of transmitted data is now worth what twenty was.

The ceiling, then, is $105.55 a month plus $41.42 per further twenty minutes. The floor is what the claims show. In 2024, PTs billed 41,785 units of 98980 for 23,546 patients, under two months of management each. RTM gets sold as recurring revenue. In the data it behaves like a short episode that ends when the course of care does.

Can a PT bill RTM?

Yes, settled since 2022. CMS designated the codes “sometimes therapy,” which in its own therapy dispositions means they are “always therapy” services when furnished by a therapist. Under a PT, RTM runs on a therapy plan of care and every claim carries the GP modifier. APTA’s practice advisory, updated January 2026: “Physical therapists may bill these RTM codes under Medicare, and the codes also may be billable under commercial insurance plans.”

Two details decide whether it works in a real clinic. Since CY 2024, CMS permits general rather than direct supervision for RTM a therapist does not personally perform, so the PT need not be in the building. And when a PTA does the management work, the CQ modifier and the de minimis standard apply, paying 85%.

RTM or RPM?

Different benefit, and the gap is why RTM exists. From the 2022 rule: “RPM services are considered to be E/M services and physical therapists, for example, are not permitted to furnish E/M services.” RPM also wants physiologic measurements uploaded by the device, where RTM data, CMS says, “can be patient reported, as well as digitally uploaded.” Both need a device meeting the FDA definition in section 201(h) of the Food, Drug and Cosmetic Act, which rules out a spreadsheet and a group text. A patient telling an app how the home program went is RTM. A cuff sending blood pressure is RPM, and not yours to bill.

The twenty minutes is where RTM stops being free money

98980 buys twenty minutes of clinical time in a calendar month, and CMS adopted CPT’s condition on it word for word. The codes “require a live, interactive communication with the patient/caregiver. The interactive communication contributes to the total time, but it does not need to represent the entire cumulative reported time of the treatment management service.”

Live and interactive. Not a dashboard alert somebody acknowledged, not an automated nudge, not adherence charts read on a Friday afternoon. CMS declined to list approved channels, saying only that it is “not specifying further exclusions for the types of communications that can be had with the patient/caregiver.” Then it added the line worth taping to a monitor: “no time or effort should be counted more than once toward the required time for any services.” The five minutes you spent on the home program during Tuesday’s visit are not also RTM minutes.

Price that honestly. Twenty minutes of licensed time, plus device management, plus the note, for $54.11. Call it $162 an hour, a fine trade if the hour exists. Where the person making those calls is also running the schedule and chasing authorizations, it is a second job.

RTM spends the same threshold your visits do

Almost nobody models this one, and it moves the answer. RTM under a PT is a therapy service with a GP modifier on it, so it counts against the therapy threshold. The Medicare Claims Processing Manual, chapter 5 gives the mechanism in a sentence: “The CWF will capture the amount and apply it to the limitation whenever a service is billed using the GN, GO, or GP modifier.” CMS’s dispositions confirm the reverse, that the thresholds stop applying only when a sometimes-therapy code is not a therapy service at all.

For 2026 that threshold is $2,480 for PT and SLP combined. Three months of RTM on a musculoskeletal patient is about $340 of it. On a long course of care, RTM revenue does not sit beside your visit revenue. It competes with it.

What is final for 2027, and what is only proposed

Only the 2026 column above is final. CMS published the CY 2027 proposed rule on July 16, comments close September 14, 2026, and last year’s final rule landed on November 5. Four things in it matter here, all citing OIG findings that “about 43 percent of enrollees who received remote patient monitoring did not receive all 3 components of it.”

Device values fall. CMS says it is “concerned that, due to lack of information regarding the typical device used to perform these procedures, these services are overvalued,” and proposes crosswalking the device codes to an ECG monitoring code’s inputs. On the rule’s own Addendum B, 98977 and 98985 drop from 1.54 total non-facility RVUs to 1.25, which is $41.05 at the proposed $32.84 conversion factor against $51.44 today. About 20% off. Treatment management barely moves.

Third-party staff stop counting. CMS proposes to pay only “when furnished by clinical staff employed by the practice,” saying the codes “could not be billed in cases where the service is not performed by clinical staff of the billing practitioner.” If a vendor’s nurses make your monthly calls under your NPI, that ends on January 1. Read the contract now, not in January. There is more of the same in what the 2027 fee schedule pays your practice.

Established patients, and a real initiating visit. RTM would be limited to established patients and would need a separately reportable face-to-face visit, in person or by telehealth, at which RTM is actually discussed. That last clause has teeth: a visit where nobody mentioned monitoring cannot be relabelled the initiating visit afterwards. PT telehealth is authorized only through the end of 2027, which is its own countdown.

A bundle is under consideration, not proposed. CMS is taking comment on collapsing all seventeen remote monitoring codes into four G-codes. The therapy one would pay per month for device supply, two or more days of data, and management “requiring at least one real-time interactive communication with the patient or caregiver; time totaling at least 20 minutes.” Bundled that way, a month without the live call pays nothing.

So is RTM worth it for your practice?

Conditional, and worth ten minutes against your own caseload rather than a vendor’s model. Three things have to be true at once. Enough Medicare patients on a long course of care that twenty a month is realistic. A person whose week actually contains those calls. A device fee that leaves enough of the $51.44 to be worth the administration. Miss one and you are running a program that clears a few thousand a year while spending a threshold you needed for visits.

If you do run it, the record is what you are really buying. An RTM claim is a monthly assertion, not a per-visit one, and it has to hold up a year later: consent, a plan of care naming the monitoring, the days data actually transmitted, the date and substance of the live conversation, the minutes, the modifier. When that evidence sits in a vendor’s portal and the visits sit in your EHR, an audit is a hand reconciliation of two systems never built to agree. It is the failure CMS blames for 88.6% of improper payments to PTs in private practice, where the code was right and the record could not carry it.

Which makes the version that survives review a dull one: monitoring evidence in the same chart as the visits, minutes captured where the rest of the clinical time is. Aurora drafts the note inside that record while you treat, so the plan of care, the payer and the episode are in hand rather than reassembled at claim time, and the documentation and the claim come out of one place. Focus on your patient, not your keyboard. An app bolted to the side of an EHR only ever sees its own half of the case.

One last thing before September 14. If RTM is real money for you, comment on CMS-1848-P with your invoices in it. CMS says it has “received very little invoice or pricing information from interested parties for the specific devices used in RTM and RPM services,” which is exactly why it thinks the codes are overvalued. It is asking. Almost nobody will answer.