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

As remote therapeutic monitoring (RTM) continues to shape modern healthcare, providers are leveraging digital health solutions to enhance patient engagement, optimize therapy adherence, and improve treatment outcomes. CPT code 98975 plays a crucial role in this transformation, allowing healthcare organizations to be reimbursed for the initial setup and education required for RTM programs.

For providers implementing RTM in musculoskeletal, respiratory, and other chronic condition management, understanding the billing requirements, documentation standards, and reimbursement guidelines for CPT 98975 is essential. This guide explores how to use this code effectively, maximize compliance, and ensure financial sustainability while delivering high-quality remote care.

• CPT Code 98976: Remote Respiratory Monitoring Devices

• CPT Code 98977: Maximizing Reimbursement for RTM Devices

• CPT Code 98980: RTM Treatment Management & Provider Guidelines

• CPT Code 98981: Extended RTM Treatment

What is CPT Code 98975?

CPT code 98975 is designed to cover the setup and initial patient education associated with remote therapeutic monitoring. It is billed once per episode of care and reimburses providers for their time in:

• Setting up the RTM device and software for patient use.

• Providing comprehensive patient education on device functionality and therapeutic goals.

• Ensuring the patient understands how to interact with RTM technology for optimal adherence.

This code is critical for establishing a strong foundation for remote monitoring success, ensuring patients are well-equipped to use RTM technology effectively throughout their treatment.

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Why CPT 98975 Matters in Digital Health Expansion

The growing emphasis on value-based care requires long-term patient monitoring, proactive interventions, and data-driven decision-making. RTM services bridge the gap between traditional care and digital health by enabling continuous patient engagement without frequent in-person visits. Given that access to health information has increased with technology, patients are more aware of their care options than ever before.¹

CPT 98975 is particularly valuable because it:

• Enhances patient compliance by ensuring a structured onboarding process for RTM.

• Improves treatment effectiveness by empowering patients with the knowledge to use monitoring tools correctly.

• Supports care coordination by allowing providers to remotely track progress from day one.

• Creates a reimbursable entry point for healthcare organizations integrating RTM into their practice.

By correctly implementing CPT 98975, providers can increase patient retention, reduce technology-related frustrations, and enhance the long-term success of remote monitoring programs.

Billing CPT Code 98975: Key Requirements for Reimbursement

To successfully bill for CPT 98975, providers must meet the following requirements:

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

• The setup must involve a prescribed, FDA-cleared RTM device with automated data transmission capabilities.

• The provider must conduct patient education on how to use the device and software effectively.

• The service is billable once per episode of care, meaning it cannot be repeated for the same treatment plan unless a new episode begins.

Medicare reimbursement and payment rates

As of 2024, Medicare reimburses approximately $18–$25 for CPT 98975. However, reimbursement amounts vary based on regional Medicare Administrative Contractors (MACs) and private payer policies.

To ensure accurate reimbursement, providers should:

• Confirm patient eligibility for RTM services under their payer's guidelines.

• Verify regional reimbursement rates by reviewing the CMS Fee Schedule.

• Document all setup activities and patient interactions to comply with Medicare and private insurance standards.

Challenges in Implementing CPT 98975 for RTM Programs

While CPT 98975 offers an important billing opportunity, providers often encounter barriers when incorporating RTM setup and education into clinical workflows.

1. Educating patients on RTM technology

• Many patients struggle with digital health tools, leading to low engagement and improper device usage.²

• Providers must ensure that education sessions are clear, accessible, and tailored to the patient's needs.

• Offering ongoing support resources (e.g., instructional videos, patient portals, or follow-up calls) can reinforce proper RTM usage.

2. Navigating compliance and documentation risks

• Incomplete documentation can lead to claim denials or payer audits.

• Providers must track patient education details, device activation logs, and initial engagement metrics.

• Implementing standardized intake forms and training protocols can ensure proper billing compliance.

3. Variability in payer policies

• Not all private insurers reimburse CPT 98975, creating coverage inconsistencies across patient populations.

• Providers must proactively review payer policies and negotiate RTM coverage where possible.

• Aligning RTM billing strategies with value-based care models can improve contract negotiation leverage with insurers.

Best Practices for Implementing CPT 98975 in RTM Workflows

To optimize reimbursement and improve RTM program outcomes, healthcare providers should incorporate the following best practices:

1. Establish a clear RTM onboarding process

• Use a standardized patient education protocol to ensure consistent training across all RTM users.

• Provide written and digital resources that patients can refer to after the initial setup.

• Offer dedicated RTM support staff to assist with device activation, troubleshooting, and patient concerns.

2. Implement structured documentation practices

• Record all interactions related to RTM setup and patient training.

• Maintain logs of device activation, software setup, and patient usage verification.

• Ensure that billing documentation aligns with CMS and private payer compliance requirements.

3. Monitor patient engagement and early adoption trends

• Identify patients who may need additional support with RTM technology.

• Track early usage trends to ensure successful integration into care plans.

• Use automated reminders or patient follow-ups to reinforce engagement.

4. Stay updated on Medicare and private payer policies

• Regularly review CMS guidelines and regional MAC fee schedules for RTM updates.

• Monitor private insurer policies to identify new coverage opportunities.

• Engage in proactive contract discussions with payers to ensure RTM services are included in reimbursement agreements.

5. Integrate RTM setup with broader digital health initiatives

• Align RTM onboarding with chronic care management (CCM) or transitional care management (TCM) programs.

• Utilize predictive analytics to assess which patients benefit most from RTM adoption.

• Explore hybrid care models that blend remote monitoring with in-person visits for enhanced patient oversight.

Case Example: Implementing RTM for Post-surgical Rehabilitation

A physical therapist works with a 55-year-old patient recovering from total knee replacement. The patient has been prescribed a structured rehabilitation program to regain mobility and strength but has concerns about staying consistent with at-home exercises.

To support adherence, the therapist introduces an RTM program using an FDA-approved wearable sensor that tracks the patient’s knee range of motion and activity levels. The therapist sets up the device, ensuring it is properly calibrated and synced with the RTM platform. They educate the patient on correctly wearing the device, sync data with the clinic’s system, and interpret basic feedback. The therapist also explains how the clinic will use the collected data to adjust the rehabilitation plan and provide feedback between visits. Before the session ends, the patient demonstrates how to use the device, confirming their understanding.

After two days of remote monitoring, the therapist reviews the transmitted data and notices that the patient is not fully extending their knee during prescribed exercises. Additionally, their movement data suggests hesitation in weight-bearing activities. The therapist contacts the patient to review the exercise, provides guidance on improving technique, and reassures them about pain management strategies.

Over the next 72 hours, follow-up monitoring shows improved knee extension and increased weight-bearing activity. With continued remote tracking, the therapist ensures that the patient remains engaged in their rehabilitation program and makes necessary modifications to their care plan.

Reporting and billing

• Bill one unit of CPT 98975 for the initial setup and patient education on using the RTM device.

• Bill only after monitoring has occurred for at least 16 days, per CMS guidelines.³

Leveraging CPT 98975 for RTM Growth

As digital health solutions continue to redefine patient care, CPT 98975 offers a crucial reimbursement opportunity that supports the initial setup and education needed for effective RTM adoption.

For healthcare providers, the key to success lies in:

• Standardizing the RTM onboarding process to improve patient adoption.

• Ensuring documentation accuracy to prevent claim denials.

• Staying informed on payer policies to expand reimbursement opportunities.

• Integrating 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. 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. Mumtaz, H., Riaz, M. H., Wajid, H., Saqib, M., Zeeshan, M. H., Khan, S. E., Chauhan, Y. R., Sohail, H., & Vohra, L. I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Frontiers in digital health, 5, 1203945. https://doi.org/10.3389/fdgth.2023.1203945

2. Marzban, S., Najafi, M., Agolli, A., & Ashrafi, E. (2022). Impact of Patient Engagement on Healthcare Quality: A Scoping Review. Journal of patient experience, 9, 23743735221125439. https://doi.org/10.1177/23743735221125439

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