RTM Most Commonly Asked Questions: Answers from a Live Clinician Q&A

TL;DR

• This recap answers questions clinicians asked during Physitrack’s live RTM 101 webinar rather than serving as a generic billing reference.
• RTM adds digital exercise completion, pain, difficulty, and repetition feedback to a home exercise program between visits.
• RTM CPT codes cover patient setup and engagement or clinician treatment-management time, with different billing thresholds for each bucket.
• The webinar cited average Medicare reimbursement of about $150 per patient per 30-day period. Physitrack charges $8 per enrolled patient episode plus $6 per clinician license each month.
• In physical therapy, the treating physical therapist must bill, and the patient must remain under an active plan of care. The recap preserves the speaker’s uncertainty about same-day setup timing and notes that the CCM question went unanswered.

RTM basics: what it is and how the codes work

The webinar began with the practical questions clinicians ask when deciding whether RTM fits their care model.

What is RTM in plain terms?

Dr. Milica McDowell described remote therapeutic monitoring as a “fancy HEP” with monitoring added to the home exercise program. The clinician prescribes exercises as usual, while the patient reports information such as pain, difficulty, and completed repetitions through the digital program. RTM gives the clinician information about what happens between appointments and supports adjustments to the plan of care.

What is RTM not?

RTM does not replace in-person visits or the judgment of the treating physical therapist. Automated tracking records patient activity, but the clinician still reviews the data and decides whether to change the program. The webinar framed RTM as an early-warning tool that can identify problems between visits.

What’s the difference between the two sets of CPT codes?

The webinar grouped the RTM CPT codes into a patient-engagement bucket and a therapeutic-management bucket. The patient-engagement bucket starts with 98975 for initial setup and patient education, which is billed once per episode of care. The remaining patient-engagement codes, 98985 and 98977, depend on how many days of data the patient transmits during a rolling 30-day period, and only one of the two applies per period. The therapeutic-management bucket covers clinician time spent reviewing data, communicating with the patient, and adjusting treatment, billed under 98979, 98980, or 98981 depending on how many minutes of qualifying time accrue in a calendar month.

How do the patient-engagement thresholds work?

The patient must transmit data on separate days within a rolling 30-day period before the relevant patient-engagement code qualifies. The webinar discussed a minimum of two monitored days for the first threshold, which corresponds to 98985, and at least 16 monitored days for the higher threshold, which corresponds to 98977. Physitrack records qualifying in-app activity automatically, but clinicians should verify current code requirements because CMS rules can change.

How do the therapeutic-management codes work?

Codes 98979, 98980, and 98981 cover time that the clinician spends managing treatment remotely, billed per calendar month rather than per rolling 30-day period. Qualifying work can include phone or telehealth conversations, secure messages, data review, and program changes. 98979 applies to the first 10 minutes plus at least one interactive communication, 98980 applies once that time reaches 20 minutes, and 98981 covers each additional 20-minute increment beyond that. Physitrack records activity completed inside the platform, while clinicians must manually document qualifying interactions conducted elsewhere.

How much does Medicare actually reimburse?

The speaker cited average Medicare RTM reimbursement of about $150 per patient for a 30-day billing period when the applicable code thresholds are met. Actual RTM reimbursement varies with the codes earned, the Medicare fee schedule, geographic adjustments, and the patient’s coverage. Medicare Part B accounts for most current RTM billing, while private-insurer coverage varies by plan and state.

Billing and cost mechanics

Do Medicare patients have a copay for RTM?

Medicare Part B generally leaves the patient responsible for 20% coinsurance on eligible RTM services. A secondary insurance plan may cover some or all of that amount. Private insurance cost sharing depends on the patient’s specific plan.

Does a deductible apply?

A deductible may apply based on the patient’s Medicare or private insurance coverage. RTM charges contribute to the same annual Part B deductible and cost-sharing structure as other covered Part B services. Your billing staff should verify the patient’s benefits before enrollment.

How do the $8 per-episode and $6 per-license fees work together?

Physitrack charges $6 per clinician license each month to enable RTM. A clinic with 10 enabled licenses would pay a $60 monthly add-on. The license fee also includes access to Physicourses, Physitrack’s continuing education platform.

Physitrack separately charges $8 for each patient enrolled in an RTM episode. The webinar described that fee as one flat charge for the episode rather than a weekly charge. A six-week or 12-week plan of care would still carry one $8 patient charge.

The webinar cited average Medicare reimbursement of about $150 per patient episode, though actual RTM reimbursement depends on the codes earned, payer rules, location, and fee schedule.

When does the $8 patient charge trigger?

Physitrack triggers the $8 charge when the patient first opens and uses the RTM program. Simply enabling RTM for a patient does not create the charge. If the patient never logs in, Physitrack does not assess the episode fee.

What happens at the end of each 30-day RTM window?

Physitrack pauses the window for clinician review rather than closing it automatically. The clinician selects “Review RTM,” checks the recorded activity, and chooses whether to continue or close the episode. Approval closes that billing window and prevents additional time or activity from being added to it.

Does Physitrack automatically send RTM billing data to the EMR?

An active back-end integration can transfer approved RTM billing data after the clinician completes the review. Physitrack sends the eligible codes and their configured rates into the connected EMR. In-app exercise sessions, feedback, and messaging are recorded automatically, while phone calls or video visits completed outside Physitrack require manual time and note entry.

Why might Epic access work even though RTM billing data does not auto-file?

Epic integrations can operate at three separate tiers. The first tier supports single sign-on, the second gives patients MyChart access to PhysiApp and their exercise program, and the third transfers back-end billing data. A clinic may have the first two tiers without the third, so staff can access Physitrack through Epic even though billing codes do not flow back automatically.

Clinics with that issue should ask Physitrack which Epic integration tier they have. If no back-end integration exists, staff can download a PDF containing billable codes, completed exercises, and notes, then upload it manually to their billing or revenue cycle software.

Eligibility edge cases

Can a PTA bill RTM CPT codes?

No. The webinar answer stated that PTAs cannot bill RTM codes. The therapeutic management codes involve reviewing patient data and adjusting the plan of care, which falls outside a PTA’s scope. The treating physical therapist must submit the RTM billing.

Can an MA or NP bill instead of the treating physical therapist?

No. RTM billing follows the clinician responsible for the patient’s plan of care. A physical therapist cannot delegate the billing to a medical assistant, nurse practitioner, or other assistant who is not the treating clinician on that plan.

Can chiropractors bill RTM codes?

Chiropractors who can bill Medicare Part B may generally be able to use the RTM benefit. Dr. Milica McDowell recommended confirming eligibility with a compliance officer because billing authority and scope requirements may differ by clinician type and jurisdiction.

Can home health clinicians bill RTM?

The answer depends on whether the agency bills the care under Medicare Part A or Part B. Medicare Part A home health operates under a different benefit structure than outpatient care billed under Part B, even when a clinician delivers that outpatient care in the patient’s home.

Based on Dr. McDowell’s clinical experience, Part B billing should generally permit RTM when the other requirements are met. She did not present that answer as settled guidance and recommended an agency-specific review with a compliance officer.

Can a cash-pay practice use RTM?

Yes. A cash-pay practice can use remote monitoring technology as an upgraded service or subscription without submitting RTM CPT codes to Medicare. The practice can then set its own service structure because Medicare billing thresholds and plan-of-care rules do not govern a service for which Medicare receives no claim.

A clinic should describe the offering carefully so patients understand whether they are purchasing a cash service or receiving an insurance-billed RTM service.

Can RTM continue after discharge for a patient with chronic pain?

Medicare RTM billing requires an active plan of care. A clinic cannot continue billing Medicare after discharging the patient, even when chronic pain causes the patient to return for repeated episodes of care.

A cash subscription may keep the patient engaged with monitoring between episodes, but the clinic cannot bill Medicare for that gap. Medicare RTM billing may resume when the patient begins a new active plan of care, whether the diagnosis code remains the same or changes.

Must the initial RTM setup happen on the same day as an in-person exam?

Dr. McDowell’s best understanding was that the initial setup should occur on the same date of service as an in-person visit. She explicitly rated her confidence as “B-plus, A-minus as far as accuracy” and said Physitrack would confirm the requirement. Clinicians should verify the timing rule before building it into their billing workflow.

After setup, the patient can complete sessions between visits. The software does not impose a minimum frequency for later in-person appointments. Your organization’s compliance policies, state rules, and requirements for maintaining an active plan of care determine that frequency.

Can RTM and chronic care management be used together?

The webinar did not resolve this question. The attendee used the acronym CCM, and Dr. McDowell said she was not familiar enough with the intended reference to answer. Clinics should seek billing or compliance guidance rather than infer an answer from the session.

Can RTM be billed in med-legal cases?

The answer depends on the insurer paying the claim and the applicable state requirements. The webinar did not treat med-legal RTM eligibility as part of standard Medicare guidance. Questions involving chiropractors, home health, CCM, or med-legal claims should go to a qualified compliance officer or billing specialist.

Getting RTM running in your own practice

A clinic can evaluate RTM technology quickly, but implementation depends on its billing and compliance rules. You need to confirm which payers cover RTM, who can bill under the active plan of care, how your clinic handles patient coinsurance, and whether your EMR integration sends billing data or only supports sign-on and patient access. A billing or compliance specialist can resolve those practice-specific questions more reliably than a feature checklist.

Physitrack’s RTM platform gives clinicians the dashboard described in the webinar, including patient activity, CPT eligibility, and remote review time. You can also discuss the integration tier your clinic needs and how billing records will reach your EMR. Reviewing those workflows against your current policies gives you a practical implementation plan before enrollment begins.