CPT Code 98977 Explained: Maximizing Reimbursement for RTM Devices

As remote therapeutic monitoring (RTM) becomes a cornerstone of digital health, healthcare providers are increasingly turning to technology-driven solutions to track therapy adherence, patient progress, and treatment effectiveness outside of clinical settings. CPT code 98977 plays a critical role in enabling these efforts, providing reimbursement for the supply and use of RTM software applications designed to monitor musculoskeletal and respiratory conditions.

For healthcare organizations integrating RTM into patient care, understanding the billing requirements, compliance protocols, and best practices associated with CPT 98977 is essential. This guide explores how providers can successfully bill for this service, optimize patient engagement, and ensure financial sustainability while meeting Medicare guidelines.

• CPT Code 98975: Reimbursement for RTM Device Setup & Patient Education

• CPT Code 98976: Remote Respiratory Monitoring Devices

• CPT Code 98980: RTM Treatment Management & Provider Guidelines

• CPT Code 98981: Extended RTM Treatment

Decoding CPT code 98977: What it Covers and Why it Matters

CPT 98977 is designated for the provision of software applications that support remote therapeutic monitoring. This code specifically applies to FDA-cleared medical devices that automatically collect and transmit patient data related to the musculoskeletal system.

What CPT Code 98977 covers

• Software-based remote therapeutic monitoring designed for ongoing therapy management.

• Automated data collection from a prescribed RTM device.

• Transmission of non-physiological data, such as therapy adherence and patient response.

• Support for musculoskeletal and respiratory conditions through continuous monitoring.

Unlike remote physiological monitoring (RPM), which tracks biometric data like blood pressure and heart rate, RTM focuses on patient-reported outcomes, therapy adherence, and treatment response for musculoskeletal and respiratory conditions.¹

By leveraging CPT 98977, providers can enhance patient engagement, reduce therapy disruptions, and track progress remotely, all while securing reimbursement for the software and monitoring infrastructure that powers these programs.

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Why CPT 98977 Is a Game-Changer in Digital Health

The rise of value-based care models has emphasized long-term condition management and proactive patient engagement. RTM solutions enable providers to monitor patients in real-time, intervene when necessary, and prevent unnecessary hospital visits.

By implementing CPT 98977 billing, healthcare organizations can:

• Encourage therapy adherence by tracking patient compliance remotely.

• Optimize care coordination by integrating real-time data with treatment plans.

• Enhance reimbursement opportunities through digital health expansion.

• Reduce healthcare costs by preventing complications that arise from non-adherence.

As Medicare and private insurers continue to embrace technology-driven patient management, CPT 98977 offers an essential pathway for healthcare organizations to expand remote care models while ensuring financial viability.

How to Bill CPT Code 98977: Key Requirements for Reimbursement

To successfully bill for CPT 98977, healthcare providers must adhere to strict eligibility requirements set by Medicare and other payers.

• The patient must be actively enrolled in an RTM program for musculoskeletal therapy.

• The prescribed device must be FDA-cleared and capable of automatic data transmission.

• The software application must collect and transmit patient data for16 days within a 30-day period.

• The RTM platform must be used for ongoing patient management, not for one-time assessments.

• The device must be billed under a therapy plan of care if it is therapy-specific.²

Failing to meet these conditions can result in claim denials, limiting the financial benefits of RTM implementation.

Medicare reimbursement and payment rates

As of 2024, Medicare reimburses approximately $50–$55 for CPT 98977. However, reimbursement rates vary based on regional Medicare Administrative Contractors (MACs) and private payer policies.

To optimize billing outcomes, providers should:

• Regularly review CMS Fee Schedules to track updates in RTM reimbursement rates.

• Verify private insurance policies to ensure CPT 98977 is covered in their reimbursement structure.

• Maintain accurate and compliant documentation to avoid delays or denials in payments.

Providers can maximize their financial returns by ensuring proper compliance and documentation while delivering high-quality remote care.

Challenges in Implementing CPT 98977 for Remote Therapeutic Monitoring

While CPT 98977 creates a reimbursement pathway for digital health services, healthcare providers must navigate several operational challenges when integrating RTM programs.

1. Selecting the right software and devices

• RTM software applications must meet FDA guidelines for therapeutic monitoring.

• The platform should enable automated data transmission without requiring manual patient input.

• Choosing interoperable software that integrates with EHR systems is essential for seamless data management.

2. Ensuring patients engage with the technology

• Medicare requires at least 16 days of patient data transmission per billing cycle.

• Low patient engagement or improper device usage can lead to missed billing opportunities.

• Providers should implement educational strategies, reminders, and automated nudges to encourage therapy adherence.

3. Compliance and documentation risks

• Proper record-keeping is essential for audit readiness and payment security.

• Providers must track software activation, device usage, and therapy adherence to ensure billing accuracy.

• Failure to meet compliance standards can result in financial penalties or claim rejections.

Addressing these challenges necessitates a structured approach to RTM implementation, backed by technology, patient education, and effective administrative practices.

Best Practices for Implementing CPT 98977 in RTM Programs

To fully leverage CPT 98977, healthcare providers should adopt strategic approaches that improve patient engagement, streamline billing processes, and enhance financial stability.

1. Select high-quality RTM software and devices

• Choose FDA-approved software applications with proven therapeutic benefits.

• Ensure the platform automatically collects and transmits therapy adherence data.

• Verify that the software is compatible with existing EHR and billing systems.

2. Improve patient engagement and therapy compliance

• Educate patients on the importance of continuous therapy monitoring.

• Use automated alerts and reminders to encourage consistent data transmission.

• Track patient engagement metrics to identify potential non-adherence risks early.

3. Maintain detailed documentation for compliance

• Keep comprehensive records of software deployment, patient usage, and adherence patterns.

• Standardize billing documentation workflows to minimize claim denials.

• Ensure data privacy and security by adhering to HIPAA and CMS guidelines.

4. Stay ahead of Medicare and payer policies

• Regularly review CMS updates and regional MAC policies.

• Monitor private payer policies to determine reimbursement eligibility.

• Work with RTM billing specialists to ensure claims align with regulatory requirements.

5. Integrate RTM into a broader digital health strategy

• Combine RTM services with chronic care management initiatives for holistic patient oversight.

• Utilize predictive analytics to assess therapy effectiveness and patient trends.

• Explore hybrid care models that integrate both in-person and remote patient management.

Case Example: Remote Monitoring for Post-operative Knee Rehabilitation

A physical therapist is working with a 45-year-old patient recovering from an anterior cruciate ligament (ACL) reconstruction. The patient has been prescribed a structured rehabilitation program but has difficulty maintaining consistency with their home exercise program.

To improve adherence, the therapist introduces an FDA-cleared RTM software application that pairs with a wearable motion sensor. The software automatically tracks the patient's knee range of motion, activity levels, and adherence to their rehabilitation exercises. The RTM platform enables the therapist to remotely monitor progress and adjust the rehabilitation plan based on real-time data.

The therapist sets up the RTM software on the patient's smartphone and ensures the motion sensor is calibrated correctly. They guide the patient through the app's features, demonstrating how to track daily exercises, receive feedback on movement quality, and set reminders for completing therapy sessions. The patient uses the app to ensure they can effectively engage with the software.

Over the next two weeks, the therapist reviews data from the RTM platform and notices that the patient is completing exercises inconsistently and is struggling with full knee extension. The therapist schedules a virtual check-in, reviews the exercise techniques, and modifies the program to better support the patient's recovery.

By the end of the 30-day period, remote monitoring has helped the patient improve adherence, leading to a better range of motion and functional outcomes. The therapist continues to monitor progress through the software, making data-driven adjustments to the rehabilitation plan as needed.

Reporting and billing

• Bill one unit of CPT 98977 for the supply and use of the RTM software application for musculoskeletal monitoring.

• Bill only after the software has collected and transmitted data for at least 16 days within a 30-day period, per CMS guidelines.³

The Full Potential of CPT 98977

As digital health solutions reshape patient care, CPT 98977 provides a crucial reimbursement mechanism for software-driven therapeutic monitoring. Healthcare providers can maximize the benefits of RTM by:

• Choosing the right RTM technology that supports automated therapy tracking.

• Optimizing patient engagement to ensure consistent device usage and data transmission.

• Maintaining accurate documentation to comply with Medicare billing requirements.

• Staying updated on reimbursement policies to secure stable financial returns.

With Medbridge Pathways, you can enable RTM for patients and automatically collect patient engagement data as they progress. Pathways has been built from the ground up to support highly engaging and effective digital care, and we are continuously optimizing and experimenting in Pathways to drive higher engagement in those first 30 days.

Pathways also provides a hub for providers to monitor patient progress, get feedback, and document their interactions. Providers can also interact with patients in Pathways via messaging in between visits, which they can use to check on patients status, respond to feedback, and more.

With Pathways, you get a digitally engaging platform for hybrid care that provides a single place to track RTM codes and then easily document it over to the EMR.

Disclaimer: The information contained in this document does not, and is not intended to, constitute legal, billing, or regulatory advice or guidance. All information, content, and material is for general information purposes and independent review and/or counsel should be obtained before making any legal or billing decisions.

References

1. American Medical Association. (2022, April 15). As remote patient monitoring expands, so does CPT to describe it. https://www.ama-assn.org/practice-management/cpt/remote-patient-monitoring-expands-so-does-cpt-describe-it

2. American Physical Therapy Association. (2023, March). Practice advisory: Remote therapeutic monitoring (RTM) codes. https://www.apta.org/contentassets/95321a10e951408db650e2f19b96699f/apta-practice-advisory-rtm-codes032023.pdf

3. APTA Practice Advisory: Remote Therapeutic Monitoring Codes Under Medicare, March 8th, 2023. https://www.apta.org/contentassets/95321a10e951408db650e2f19b96699f/apta-practice-advisory-rtm-codes032023.pdf