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RPM and RTM, an introduction for 2025
Contributions by Abid H.
Remote Patient Monitoring billing (RPM) has made it easier for providers to keep track of patients without asking them to come in all the time. It gives a quick look at things like blood pressure or oxygen levels while the patient stays at home. It’s a simple setup, but it helps catch problems earlier and makes routine care a lot smoother.
Remote Therapeutic Monitoring (RTM) builds on this by focusing more on how patients follow treatment plans — such as physical therapy routines or medication use. Both services are now widely supported by Medicare, and more clinics are offering them to improve outcomes and reduce hospital visits.
That said, billing for these services isn’t always clear-cut. Medicare has specific rules on how they’re documented, who can bill them, and when codes can be used. Without a proper understanding, even eligible services can get denied — which is frustrating for staff and costly for providers.
In this guide, we’ll break it all down. You’ll learn the basics of RPM and RTM billing, what Medicare expects in 2025, and how these programs compare to other care management services. We’ll also look ahead to 2026 so you can stay ready for any changes on the horizon.
What is Remote Patient Monitoring and Remote Therapeutic Monitoring
Remote monitoring makes it possible for healthcare providers to manage the care of patients outside of clinics between visits using digital tools. It keeps providers connected to real-world patient progress and supports better clinical decisions throughout the month.
Remote Patient Monitoring
RPM uses medical devices to automatically collect vital signs like blood pressure or glucose. That data is sent to the provider so issues can be addressed early—not weeks later.
🔹 Devices are FDA-approved and transmit data without manual input
🔹 Medicare requires at least sixteen days of readings each month
🔹 Common in chronic care programs for hypertension, diabetes, and heart failure
🔹 Remote patient monitoring billing must follow CMS time and supervision rules
Remote Therapeutic Monitoring
RTM focuses on therapy response rather than vitals. It collects data through software or wearable tools and is often used for pain management, recovery, and behavioral health programs.
🔹 Tracks symptoms progress and therapy adherence
🔹 Data can be passively collected or self-reported
🔹 Often used by physical therapists or specialists managing rehab
🔹 Must meet CMS criteria for direct supervision and therapeutic use
Together, RPM and RTM support a more proactive model of care by helping providers act on real-time health trends—not just visit notes.
- 99453 — This code covers the initial setup of the device and the time spent educating the patient. It’s a one-time charge tied to the start of service.
- 99454 — This is billed every 30 days and covers the device supply and data transmission. CMS requires 16 days of data within that billing period to qualify.
- 99457 — This code is used when the care team spends at least 20 minutes reviewing the patient’s data and communicating with them live — by phone or video. It’s billed once per calendar month.
- 99458 — An add-on to 99457. This pays for each additional 20-minute block spent reviewing and interacting with the patient.
- 99091 — This is an alternative code some providers use when the physician personally reviews and interprets the data for 30 minutes. It doesn’t stack with 99457 or 99458.
To bill RPM correctly and meet RPM billing requirements for Medicare in 2025
- Use only devices that automatically record and transmit readings
- Make sure the platform captures usage data across at least 16 days
- Keep time logs for any clinical review or patient interaction
- Only one provider can bill RPM for a patient in any 30-day window
Remote Therapeutic Monitoring (RTM)
RTM works differently. It’s used for tracking therapy progress — not vitals. Think rehab programs, inhaler use, or behavior-related care plans. It often involves apps or wearable sensors, and data might come from the patient directly.
Key RTM Codes
- 98975 — Similar to 99453. This covers setup and education at the start of the therapy. You bill it once per care episode.
- 98976 — Covers respiratory therapy tracking. To bill it, the device or app needs to collect data on at least 16 days within the 30-day window.
- 98977 — Used for musculoskeletal programs, like physical therapy or pain rehab. Same 16-day requirement applies.
- 98978 — This one is more specialized. It’s used for cognitive or behavioral therapy apps that track patient activity. A lot of mental health providers are starting to use it.
- 98980 — Covers the first 20 minutes of reviewing therapy data and having a real-time conversation with the patient.
- 98981 — Add-on to 98980 for each extra 20-minute block in the same month.
A few things to keep in mind for RTM
- RTM codes require direct supervision — different from RPM’s general supervision
- Therapists and other non-physician providers can bill RTM
- The data doesn’t have to be fully automated — patient-reported info is allowed
- You can’t bill RPM and RTM for the same patient during the same 30-day period
That’s the real-world breakdown. These codes aren’t complicated by themselves — what causes problems is misunderstanding the conditions behind them. The right data, the right timing, and clean documentation are what make or break reimbursement.
RPM and RTM Growth in 2025
More states are reimbursing for remote patient monitoring and therapeutic monitoring under Medicaid. Commercial payers are also expanding coverage, especially in pain care, rehab programs, and behavioral health services.
Large provider groups are now rolling out RPM and RTM across multiple sites. Adoption is rising in clinics tied to value-based contracts and chronic care models.
Coverage keeps growing but not evenly. Billing teams need to track requirements by payer and state to avoid denials and stay compliant.
Chronic Care Management vs. RPM and RTM Billing
Understanding the differences in chronic care management vs. RPM billing can help avoid code overlap. If you’re handling claims, the line between Chronic Care Management and remote monitoring can get blurry.
Here’s a side-by-side breakdown to help your team bill the right service — and avoid overlap.
Billing Feature | Chronic Care Management (CCM) | Remote Patient Monitoring (RPM) | Remote Therapeutic Monitoring (RTM) |
Main Focus | Ongoing care coordination | Tracking vitals from devices | Tracking therapy progress (movement, behavior, meds) |
Data Source | Notes and check-ins | Device-based readings (auto-transmitted) | Patient input or app-based tracking |
Who Can Bill | MDs, NPs, PAs | MDs, NPs, PAs, clinical staff | MDs, PTs, OTs, some NPPs |
Supervision Type | General | General | Direct |
Setup Code | No setup code | 99453 | 98975 |
Monthly Service Codes | 99490, 99439, 99487, 99489 | 99454, 99457, 99458, 99091 | 98976, 98977, 98978, 98980, 98981 |
Live Interaction | Required once a month | Required for 99457 and 99458 | Required for 98980 and 98981 |
Can Bill With CCM? | — | Yes, if time and services don’t overlap | Yes, same rule applies |
Looking Ahead to 2026
CMS hasn’t finalized major changes to RPM or RTM billing for 2026 yet, but early signs suggest a continued push toward broader use.
- More states are expected to add RTM to Medicaid coverage
- CMS may tighten documentation checks for time-based codes
- Some private payers are testing bundled models that include RPM with CCM
- Multi-condition programs could see clearer billing guidance across overlapping services
It’s a good time for clinics to audit workflows and make sure RPM and RTM time tracking aligns with CMS expectations. With more audits likely ahead, clean records will matter more than ever.
Staying Compliant with RPM and RTM Billing Across Payers
Medicare billing rules for remote monitoring are clear, but each state and private payer adds its own layer. That’s why consistent documentation and payer-specific workflows matter — especially across multiple locations.
Groups working with Certified Healthcare Billing benefit from structured billing reviews and up-to-date compliance tracking for both RPM and RTM claims. Their team helps ensure that submitted codes meet CMS and state-specific guidelines.
Conclusion
Remote monitoring continues to expand, but billing success depends on staying aligned with code-specific rules, supervision levels, and payer differences. A clear understanding of RPM and RTM billing is now essential for consistent reimbursement.
As Medicare evolves and more states adopt RTM coverage, providers must keep workflows tight. Clean documentation, accurate time tracking, and knowing when services can be billed together are key in 2025 and beyond.
