CPT Code 98980 Explained: RTM Treatment Management & Provider Guidelines

The rise of remote therapeutic monitoring (RTM) has redefined how healthcare providers engage with patients, offering continuous oversight, improved treatment adherence, and proactive intervention beyond traditional office visits. CPT code 98980 is a critical component of RTM billing, allowing providers to be reimbursed for real-time patient interaction and monitoring management.

For healthcare organizations incorporating RTM into musculoskeletal, respiratory, or chronic care management programs, understanding how to bill CPT 98980 effectively, maintain compliance, and optimize patient engagement is essential. This guide explores the billing requirements, reimbursement potential, and best practices for implementing CPT 98980 in remote patient care.

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

• CPT Code 98976: Remote Respiratory Monitoring Devices

• CPT Code 98977: Maximizing Reimbursement for RTM Devices

• CPT Code 98981: Extended RTM Treatment

What is CPT Code 98980?

CPT 98980 covers the management of remote therapeutic monitoring data, including at least one live, interactive communication with the patient during a calendar month. This real-time engagement ensures that providers can assess patient progress, modify treatment plans as needed, and reinforce adherence to therapy goals.

Key features of CPT 98980

• Covers at least 20 minutes of RTM data management and patient interaction per month.

• Requires real-time communication between the provider and the patient (or caregiver).

• Applies to musculoskeletal, respiratory, and other therapeutic monitoring programs.

• Supports ongoing patient management and proactive intervention.

• Eligible for Medicare reimbursement when used in compliance with CMS guidelines.

This code is distinct from CPT 98975, which covers RTM setup, and CPT 98977, which bills for software-enabled device supply. Instead, 98980 focuses on active care management, allowing providers to ensure that RTM data translates into meaningful clinical action and improved patient outcomes.

Remote Therapeutic Monitoring: Your Guide to Successful Billing

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Why CPT 98980 Is a Key Component of Value-Based Care

As healthcare shifts toward data-driven, patient-centered models, CPT 98980 supports value-based care initiatives by ensuring continuous patient engagement. Instead of waiting for in-person visits to adjust treatment plans, providers can use RTM insights to make real-time interventions, reducing complications and improving overall patient adherence.

By integrating CPT 98980 into RTM programs, providers can:

• Improve patient adherence by reinforcing therapy goals through scheduled check-ins.

• Address issues proactively, preventing therapy drop-offs or worsening conditions.

• Increase patient satisfaction by offering real-time guidance and support.

• Reduce unnecessary hospital visits by detecting issues before they escalate.

Billing and Reimbursement for CPT 98980

Eligibility requirements

To successfully bill for CPT 98980, providers must meet the following criteria:

• The patient must be actively enrolled in an RTM program for a qualifying condition (e.g., musculoskeletal or respiratory therapy monitoring).

• The provider must spend at least 20 minutes managing patient data and conducting one or more live, interactive communications (via phone, video, or secure messaging).

• The engagement must involve clinical decision-making, such as modifying treatment plans, addressing therapy adherence issues, or guiding patients on their progress.

• The service must be delivered by a physician, qualified healthcare professional (QHP), or clinical staff under supervision.

Medicare reimbursement and payment rates

As of 2024, Medicare reimburses approximately $48–$55 for CPT 98980. However, payment rates may vary by region based on Medicare Administrative Contractors (MACs) and private payer agreements.

To ensure accurate reimbursement, providers should:

• Review CMS Fee Schedules regularly for rate updates.

• Verify private payer policies to identify additional billing opportunities.

• Document all patient interactions and data management activities to maintain compliance.

Common Challenges in Implementing CPT 98980

While CPT 98980 supports proactive patient engagement, providers often face challenges in scaling RTM services, such as increased workload and data accuracy issues. Structured workflows and standardized documentation are essential to overcoming these barriers. 

1. Patient engagement and response rates

• Some patients fail to respond to scheduled check-ins, making it difficult to meet billing criteria. However, effective patient engagement strategies can significantly improve adherence to treatment protocols and enhance compliance.¹

• Providers need to implement automated reminders and structured scheduling to ensure compliance.

• Offering multi-channel communication options (phone, video, secure messaging) can increase patient responsiveness.

2. Ensuring proper documentation for compliance

• CMS and private payers require detailed documentation of all data review activities and patient interactions.

• Providers should establish standardized reporting templates to track treatment adjustments, patient feedback, and adherence monitoring.

• Missing or incomplete documentation can lead to claim denials and reimbursement delays.

3. Variability in reimbursement policies

• Not all private insurers reimburse CPT 98980, requiring negotiation and contract reviews for expanded coverage.

• Providers should monitor payer updates and advocate for RTM integration into value-based contracts.

• Aligning RTM services with population health initiatives can increase payer acceptance and reimbursement opportunities.

Best Practices for Optimizing CPT 98980 in RTM Workflows

To maximize the effectiveness of CPT 98980, healthcare providers should implement strategic approaches that support billing accuracy, patient engagement, and clinical impact.

1. Establish a structured patient engagement plan

• Implement automated scheduling for check-ins to ensure that every RTM patient receives the required interactive session.

• Offer multiple communication options (phone, video, or secure messaging) to accommodate patient preferences.

• Track non-responsive patients and follow up with additional outreach to maintain adherence.

2. Maintain comprehensive documentation for billing compliance

• Record all RTM data management activities and patient interactions.

• Document how therapy plans are modified based on RTM data insights.

• Ensure billing records align with CMS and private payer guidelines to prevent claim rejections.

3. Monitor patient progress and adjust treatment in real time

• Use predictive analytics to identify patients at risk for non-adherence.

• Adjust treatment plans based on patient-reported progress and device-generated data.

• Ensure RTM-driven interventions align with evidence-based clinical guidelines.

4. Stay updated on Medicare and private payer policies

• Regularly review Medicare updates and MAC fee schedules.

• Work with billing specialists to identify evolving reimbursement trends.

• Advocate for RTM inclusion in private payer contracts to expand coverage.

5. Integrate RTM into broader digital health strategies

• Align RTM services with chronic disease management programs for holistic patient oversight.

• Use hybrid models that combine in-person follow-ups with remote monitoring.

• Explore AI-driven patient engagement tools to automate adherence tracking.

As remote therapeutic monitoring grows, CPT coding adapts to support new applications. Future RTM codes are expected to expand beyond musculoskeletal and respiratory care, reflecting the increasing role of digital health in patient management.² By embedding RTM within broader digital health strategies, providers can enhance patient engagement and secure long-term reimbursement success.

Case Example: Real-Time RTM Management for Post-surgical Shoulder Rehabilitation

A physical therapist is managing the recovery of a 52-year-old patient following rotator cuff repair surgery. The patient has been enrolled in a remote therapeutic monitoring program using an FDA-cleared motion tracking device that records shoulder range of motion, exercise compliance, and pain levels.

To ensure a smooth recovery, the therapist reviews the RTM data weekly. After analyzing the most recent data, they noticed that the patient’s range of motion was not improving as expected, and the pain scores had increased. Concerned about a possible adherence issue or complications, the therapist schedules a live, interactive check-in with the patient via video call.

During the session, the therapist discusses the patient’s progress, reviews their exercise technique, and assesses their shoulder mobility in real time. The patient admits to skipping certain prescribed exercises due to discomfort. The therapist provides guidance on pain management strategies, modifies the home exercise plan, and demonstrates alternative exercises that are less painful but still effective in maintaining mobility.

Over the next two weeks, the therapist continues monitoring the patient’s RTM data. A follow-up check-in confirms that the patient is now completing the entire exercise program and their pain levels have stabilized. The therapist makes additional adjustments to the rehabilitation plan to further support progress.

Reporting and billing

• Bill one unit of CPT 98980 for at least 20 minutes of RTM data analysis and management, including at least one live, interactive patient communication.

• Ensure that the interactive session involves clinical decision-making, such as modifying the treatment plan, addressing adherence issues, or reinforcing therapy goals, per CMS guidelines.³

Leveraging CPT 98980 for Smarter Remote Care

As remote therapeutic monitoring continues to reshape patient care models, CPT 98980 offers a key reimbursement opportunity that supports ongoing patient management and real-time provider engagement.

• To successfully implement CPT 98980, healthcare providers should:

• Standardize RTM patient engagement workflows to ensure regular interactive check-ins.

• Document all clinical interactions and data reviews to maintain billing compliance.

• Monitor payer policies to expand reimbursement opportunities beyond Medicare.

• Integrate RTM into broader digital health strategies for long-term success.

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 for codes 98980 and 98981. 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. Marzban, S., Namvar, M., & Aghaei, E. (2022). Impact of patient engagement on healthcare outcomes: A scoping review. Journal of Patient Experience, 9, 23743735221125439. https://doi.org/10.1177/23743735221125439

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

3. APTA Practice Advisory: Remote Therapeutic Monitoring Codes Under Medicare, March 8th, 2024. https://www.apta.org/contentassets/95321a10e951408db650e2f19b96699f/apta-practice-advisory-rtm-codes032023.pdf