Remote Therapeutic Monitoring Billing 2026

Codes, Compliance and Denial Prevention

By Yagnesh Dave  ·  September 2026  ·  13 min read

Most practices that added remote monitoring billing over the past few years built their program around RPM, remote physiologic monitoring, because it came first and because the codes are better known. What a lot of practices haven't fully built out yet is remote therapeutic monitoring, a separate code family that opened up billing for an entirely different set of conditions and, just as importantly, an entirely different set of billing practitioners. If your practice includes physical therapy, occupational therapy, speech-language pathology, or behavioral health components tracking pain, adherence, or functional status, RTM is very likely leaving revenue on the table right now, either because it isn't being billed at all, or because it's being billed in a way that mirrors RPM's rules too closely and doesn't hold up under review.

This guide covers what RTM actually is, how its five codes work, the compliance line between RTM and RPM that CMS enforces strictly, and the specific documentation gaps that turn a legitimate monitoring program into a denial pattern. Get this wrong at volume and the cost shows up fast, through denials, undercoding, or missed follow-up.

What RTM Actually Covers

Remote therapeutic monitoring tracks non-physiologic data tied to the musculoskeletal and respiratory systems: therapy exercise completion, pain levels, medication adherence, and functional status related to a treatment plan. The distinction that matters most operationally is that RTM data can be patient self-reported through an app or portal, not exclusively collected automatically by a device the way RPM requires. A patient who logs their pain score after a home exercise session, or confirms they completed a prescribed stretching routine, is generating billable RTM data. RPM has no equivalent: its entire structure assumes a device is doing the measuring, not the patient doing the reporting.

Who Can Bill RTM, and Why That's the Real Differentiator

RPM billing is tied to the physician fee schedule's E/M billing structure, which in practice means it's largely restricted to physicians and non-physician practitioners who can independently bill E/M visits. Physical therapists, occupational therapists, and speech-language pathologists cannot bill E/M codes, and as a result, they've historically been shut out of remote monitoring reimbursement entirely, despite being the exact clinicians most likely to be tracking a patient's home exercise adherence, pain trajectory, and functional recovery.

RTM was built to close that gap. PTs, OTs, and SLPs can bill RTM codes directly under their own provider number when the monitoring falls within their scope of practice, musculoskeletal and respiratory status tracking fits squarely within physical therapy and pulmonary rehab, and it's the single biggest reason therapy-heavy practices should be running an RTM program even if they've never touched RPM.

The Rule That Generates the Most Denials: RTM and RPM Can't Overlap

CMS has been explicit that RTM and RPM cannot both be billed for monitoring the same or a substantially related condition in the same service period. A patient recovering from a cardiac event who's also doing post-surgical physical therapy could plausibly have both a cardiologist running RPM on blood pressure and a physical therapist running RTM on exercise adherence; those are genuinely distinct clinical problems with separate care plans. What doesn't hold up is a single practice billing RPM for general monitoring and RTM for the same musculoskeletal condition in parallel, hoping the code distinction alone justifies both. Payers read this as duplicate billing for the same monitoring activity, and it's one of the fastest ways to trigger a post-payment review.

The 16-Day Rule and Why It Trips Up New RTM Programs

Codes 98976 and 98977 require at least 16 days of data transmission within the 30-day billing period, the same threshold RPM's device supply code uses. This catches practices off guard most often in the first month of a patient's enrollment, when setup delays, app download friction, or a patient who doesn't engage immediately with self-reporting can easily produce fewer than 16 days of usable data. Billing the device supply code anyway, based on the assumption that "close enough" data counts, is a documented denial pattern and, on audit, looks like billing for a service that didn't meet its own coverage criteria.

OIG and Payer Scrutiny of Remote Monitoring Billing

Remote monitoring billing broadly, RPM and RTM together, has grown fast since the codes expanded, and that growth has drawn program integrity attention. OIG's Work Plan has flagged remote patient monitoring as an area warranting review for medical necessity documentation, appropriate use of device supply codes, and whether treatment management time is actually being furnished and documented as claimed rather than billed as a recurring monthly charge regardless of actual clinical activity. The core concern regulators keep returning to is "set and forget" billing: enrolling a patient in a monitoring program, billing the recurring codes every month, and never demonstrating that a clinician actually reviewed the data or acted on it.

For RTM specifically, because it's newer and involves a broader set of billing practitioner types than RPM, documentation standards haven't been tested by as many audits yet, which means practices building RTM programs now have a real opportunity to get the documentation right from day one rather than retrofitting it after a payer review flags a pattern.

Common RTM Denial Patterns and Fixes

Frequently Asked Questions About Remote Therapeutic Monitoring Billing 2026

What is the difference between RTM and RPM billing?

RPM (remote physiologic monitoring, CPT 99453-99458) requires data that is automatically collected by a medical device, such as a Bluetooth blood pressure cuff or pulse oximeter, and can only be billed by physicians and certain non-physician practitioners who bill E/M services. RTM (remote therapeutic monitoring, CPT 98975-98981) covers non-physiologic data related to the musculoskeletal and respiratory systems, therapy adherence, and pain levels, and the data can include patient self-reported entries through an app rather than device-only readings. Critically, RTM can be billed by physical therapists, occupational therapists, and speech-language pathologists acting as the billing practitioner, which RPM generally cannot.

Can RPM and RTM be billed for the same patient in the same month?

CMS has been clear that RPM and RTM cannot both be billed for monitoring the same or a substantially related physiologic system or condition during the same service period, because doing so would represent duplicate monitoring of the same clinical problem. They can be billed for the same patient if they are genuinely monitoring different, clinically distinct conditions with separate care plans and separate documentation, but payers scrutinize this pattern closely and it should not be treated as a routine stacking strategy.

How many days of data are required to bill RTM device supply codes?

CPT 98976 and 98977, the RTM device supply codes for respiratory and musculoskeletal system monitoring, each require at least 16 days of data within a 30-day period before the code can be billed, mirroring the same 16-day rule that applies to RPM's device supply code 99454. If a patient's device transmits data for only 10 or 12 days in a given 30-day period, neither code can be billed for that period even if some monitoring did occur.

See how Rcmaxis handles remote monitoring billing on our Occupational Therapy billing services page.