Wearables Are Changing How PTs Monitor Patients Between Visits

Kurz gesagt

• Smartwatches and activity trackers already collect movement and activity data while patients go about daily life.
• Physical therapists have historically relied on patient recall to assess home exercise adherence and activity between visits.
• Wearables and purpose-built RTM devices can reveal activity changes, missed exercises, and progress before the next appointment.
• Wearables supply data. Remote therapeutic monitoring supplies the reimbursed clinical workflow for reviewing that data and responding when appropriate.
• Wearables and RTM serve different functions. A smartwatch alone does not establish an RTM program or make monitoring eligible for reimbursement.

The gap between what patients report and what they actually do

Physical therapists have traditionally estimated home program adherence by asking patients what happened since the previous visit. Those estimates can be inaccurate for ordinary reasons. Patients forget individual sessions, round partial completion up to full completion, or struggle to describe how pain affected their activity across several days.

Infrequent appointments create long periods with little clinical visibility. A patient may stop exercising after a pain flare on Tuesday, but the physical therapist may not learn about the change until the following week. By then, the patient may have lost confidence in the program or fallen behind an expected progression.

Self-report also removes useful context. A patient who says, “I completed my exercises most days,” may have performed fewer repetitions than prescribed or concentrated several sessions into one day. A pain score recorded during an appointment cannot reveal whether symptoms rose after activity, improved with consistent exercise, or changed alongside a broader drop in movement.

Clinicians have long wanted better information between visits, but older collection methods made regular monitoring difficult. Paper diaries depended on consistent manual entries. Phone check-ins required clinician time and reached patients only at selected moments. Even when patients recorded useful details, clinics needed a practical way to review the information and respond before the next appointment.

Continuous data can shorten those blind periods by showing when activity or adherence changes. The clinical value comes from recognizing a meaningful pattern early enough to ask a focused question, adjust the program, or schedule additional contact.

What continuous data changes for a clinic

Continuous data gives physical therapists a view of activity between scheduled visits. Instead of relying on a patient’s memory at the next appointment, a clinician can review changes across days or weeks. Those patterns may reveal a drop in activity, an abrupt increase in load, or inconsistent participation in prescribed exercise.

Consumer wearables collect passive measures during daily life. A smartwatch or activity tracker may record steps, active minutes, sleep patterns, and heart rate trends. These measures help a clinician understand general behavior, but they usually cannot confirm whether a patient completed a specific exercise with the prescribed repetitions or range of motion.

Purpose-built RTM devices collect data tied more closely to therapeutic activity. Depending on the device, a clinician may receive exercise duration, repetitions, joint movement, resistance, or patient-reported symptoms. A device designed for knee rehabilitation, for example, may show that a patient completed fewer sessions than prescribed or stopped short of a movement target.

Data still requires clinical interpretation. A declining step count could reflect pain, fear of movement, illness, or a deliberate reduction in activity. The clinician uses the pattern to ask a focused question and adjust care when appropriate.

A remote therapeutic monitoring workflow gives clinicians a structured way to review and act on relevant data. Wearables and RTM devices supply observations, while the RTM workflow organizes ongoing clinical review. Clinics need to assess each data source for clinical relevance and whether it meets applicable billing requirements.

Remote Therapeutic Monitoring as the reimbursement layer

Remote therapeutic monitoring is a CMS reimbursement pathway for reviewing therapeutic data and managing care between visits. RTM does not refer to a wearable, device, or dataset. It defines how clinicians collect qualifying data, review it, communicate with patients, and bill Medicare for that work.

For musculoskeletal care, CPT code 98975 covers initial device setup and patient education, billed once per episode. Code 98977 covers device supply and data transmission for 16 to 30 monitored days within a 30-day period, and code 98985 covers the same supply and transmission activity for a shorter window of 2 to 15 monitored days. Clinics bill one or the other, not both, for the same period. The monitoring technology must meet the FDA definition of a medical device, so data from a general consumer smartwatch may not qualify by itself.

Treatment management uses a calendar-month cadence. Code 98980 covers the first 20 minutes of clinician time, and 98981 covers each additional 20 minutes. Code 98979 provides an alternative for the first 10 to 19 minutes of treatment management when its requirements apply. Clinics should not combine alternative time pathways for the same work.

Qualifying management time includes reviewing transmitted data, assessing the patient’s response, modifying the care plan, and communicating about treatment. The established management codes require at least one interactive patient or caregiver communication during the month. Automated data collection and unrelated administrative work do not count as clinician management time.

RTM therefore pays for the clinical attention that makes monitoring useful. A device can record activity every day, but a physical therapist still needs time to interpret a change, contact the patient, and adjust treatment. Clinics should verify current CMS guidance, payer policies, documentation rules, and code combinations before billing because coverage can differ by payer.

Wearables and RTM are complementary, not interchangeable

An Apple Watch or Fitbit can supply useful activity data, but owning one does not place a patient in an RTM program. Consumer wearables may record steps, heart rate trends, sleep, or general activity. A physical therapist can use those signals to understand how movement changes between appointments.

RTM adds a defined clinical and billing workflow around therapeutic data. The clinic must use qualifying technology, collect the required data, document eligible monitoring activity, and meet the applicable billing thresholds. Treatment management codes also depend on clinician time and interactive communication with the patient. A stream of Fitbit data alone does not complete those steps.

The two components serve different functions. Wearable data can reveal a drop in activity or an unexpected load increase. The RTM workflow gives the physical therapist a structured way to review relevant data, contact the patient, adjust care, and document that work for reimbursement when the requirements are met.

Clinics should also confirm whether a consumer device produces the type of therapeutic data required for the RTM codes they plan to bill. Purpose-built RTM devices can collect exercise-specific or musculoskeletal data and support CMS requirements that a general consumer wearable may not satisfy on its own.

Post-surgical rehab: catching adherence drop-off before the next visit

A total knee replacement patient may follow the prescribed exercises closely during the first week, then reduce sessions when swelling and discomfort increase in week two. Without between-visit data, the physical therapist may not learn about the drop until the next appointment. Exercise logs can show missed sessions, while an activity tracker may reveal a sustained reduction in daily movement.

Early visibility gives the physical therapist time to investigate the cause and respond. The clinician might review pain and difficulty ratings, contact the patient, and adjust the program if symptoms are limiting participation. If confusion or concern caused the lapse, the clinician can clarify the prescription and reinforce safe movement within the surgical plan.

Delayed detection can affect early rehabilitation goals. Reduced movement and incomplete exercise may contribute to stiffness, while healing tissue can make lost range of motion harder to recover later. A patient may also miss expected range targets before anyone recognizes the pattern.

Wearable and adherence data still require clinical interpretation. A step count cannot confirm that a patient completed knee flexion exercises correctly, and a completion log cannot prove movement quality. Within an RTM workflow, these signals help the physical therapist identify a possible problem, assess it remotely, and decide whether the patient needs a program change or an earlier visit.

Chronic pain: monitoring function, not just symptoms

Continuous activity data helps a physical therapist judge function across days instead of relying on one pain score during an appointment. A patient may report less pain while also walking less, avoiding stairs, or reducing normal daily activity. The lower pain score alone could therefore overstate functional progress.

A patient with low back pain might report completing the prescribed exercises and staying active. Wearable data may instead show very low weekday activity followed by a sharp weekend increase, with pain and difficulty ratings rising afterward. The repeated cycle can suggest avoidance followed by overactivity, which gives the physical therapist a basis for discussing pacing and adjusting the home program.

Wearable trends still require clinical interpretation. A drop in activity may reflect a pain flare or an unrelated change in routine, and the device cannot explain the cause. The physical therapist can combine movement trends with patient reports and exercise adherence data to ask more targeted questions and make better-informed changes between visits.

Athletic return-to-play: managing load between sessions

Cumulative training load can change the meaning of an athlete’s progress between clinic visits. An athlete recovering from ACL reconstruction may attend physical therapy once a week while running, lifting, and practicing independently on other days. A wearable may reveal a sudden increase in running distance after several lower-load weeks, even when the athlete reports that training has gone well.

Load spikes can expose recovering tissue to demands beyond the capacity demonstrated during rehabilitation. By comparing prescribed activity with recorded duration, distance, or exercise completion, the physical therapist can identify when progression has moved faster than planned. The clinician can then reassess symptoms and function before adjusting the next training block.

Wearable records do not establish readiness for competition on their own. Physical therapists still need clinical examination, strength testing, and sport-specific assessment. Continuous load data adds context by showing what the athlete actually did between sessions, which supports more informed decisions about progression and recovery.

Where home exercise program adherence fits into the picture

The home exercise program gives monitoring data its clinical context. A step count or activity trend cannot show whether a patient followed the prescribed plan on its own. The physical therapist needs to compare those signals with the assigned exercises, dosage, and progression.

Program-level adherence data provides a more direct view. Exercise completion, logged sets and repetitions, and session-specific pain or difficulty ratings can show whether the patient performed the program as prescribed. Wearable data can add broader context by showing how the patient moved throughout the day.

For example, a patient may report completing every session while recorded activity steadily declines. Another patient may complete the assigned exercises but report rising difficulty after each session. Both patterns give the physical therapist a reason to review the program before the next appointment.

RTM creates a structured workflow for reviewing these records and responding when the data warrants clinical attention. The home exercise program remains the treatment plan, while wearable and RTM data help the physical therapist assess how that plan is working between visits.

What this means for how PTs practice

Physical therapists can supplement periodic assessments with a longitudinal view of recovery. Between-visit data can reveal when progress diverges from the plan, giving the clinician a reason to check in, reassess, or modify treatment before the next scheduled appointment.

Clinical judgment still determines whether a data change requires action. Wearable readings and adherence records gain meaning only when a physical therapist interprets them alongside symptoms, goals, and examination findings. Used this way, ongoing monitoring supports earlier, more evidence-based decisions while keeping the clinician responsible for the plan of care.

FAQs

• Is a smartwatch enough for RTM billing? An RTM device must meet applicable medical-device and data-collection requirements. A consumer smartwatch may provide useful activity data, but ownership alone does not establish RTM eligibility. Your clinic must confirm that the device, data, and clinical workflow meet current CMS rules.

• What is the difference between RTM and RPM? RTM covers nonphysiological therapeutic data, such as therapy adherence and musculoskeletal status, while remote patient monitoring covers physiological data such as blood pressure. Physitrack supports RTM workflows focused on prescribed rehabilitation. The distinction determines which coding and monitoring requirements apply.

• Does a patient need a special device? RTM requires a qualifying medical device, but patients do not always need separate wearable hardware. Software may qualify when it meets the relevant medical-device requirements and collects the required data. Your chosen RTM workflow determines what the patient needs.

• Who reviews RTM data? The clinician responsible for the patient’s care reviews the monitoring information and decides whether intervention is needed. Physitrack presents adherence and patient-reported information in the clinician dashboard. The clinician can then adjust the program, contact the patient, or document continued progress.