The Complete Guide to RTM Billing for Chiropractors (2026)

1. What is RTM (Remote Therapeutic Monitoring)?

Remote Therapeutic Monitoring (RTM) is a set of CPT codes that allow healthcare providers to bill for non-physiologic patient monitoring and treatment management services delivered remotely.

In plain English: You can bill for the time you spend managing patients between office visits.

If you're:

• Texting patients about their home exercise compliance
• Reviewing their progress data remotely
• Adjusting care plans based on their feedback
• Monitoring adherence through apps or systems
• Responding to patient questions about their treatment

You're doing RTM work. The question is: are you billing for it?

RTM vs. RPM: What's the Difference?

RPM (Remote Physiologic Monitoring) tracks physiologic data like blood pressure, glucose, weight, heart rate.

RTM (Remote Therapeutic Monitoring) tracks non-physiologic data like:

• Exercise completion and adherence
• Musculoskeletal symptoms
• Range of motion progress
• Pain levels
• Functional improvement
• Therapy compliance

2. Why RTM is Perfect for Chiropractic Care

Chiropractic care extends well beyond the adjustment table. Effective treatment requires:

• Patient education on home exercises
• Ongoing compliance monitoring
• Progress tracking between visits
• Care plan adjustments based on patient feedback
• Communication about setbacks or improvements

You're already doing this work. RTM simply allows you to get paid for it.

The Revenue Opportunity

Conservative estimate for a practice with 100 active patients:

• 40-50% qualify for RTM (patients with ongoing therapeutic programs)
• Average reimbursement: ~$85-95 per patient/month (2026 actual rates)
• Monthly RTM revenue: $4,250 - $4,750
• Annual RTM revenue: $51,000 - $57,000

For work you're already doing.

3. The Three RTM CPT Codes Explained (2026 Actual Rates)

RTM billing uses three CPT codes. Here's what each one covers with 2026 actual reimbursement rates:

Updated Revenue Per Patient (2026 Rates)

4. Who Qualifies for RTM Billing

Not every patient qualifies for RTM. Here are the criteria:

Qualifying Conditions

Patients must have a musculoskeletal condition requiring therapeutic monitoring, such as:

• Chronic low back pain
• Neck pain and cervical dysfunction
• Post-injury rehabilitation
• Posture correction programs
• Chronic joint conditions
• Neurological rehabilitation
• Sports injury recovery
• Any condition requiring ongoing therapeutic exercise

Qualifying Activities

The patient must be engaged in therapeutic activities you're monitoring:

• Home exercise programs (HEPs)
• Stretching protocols
• Postural correction exercises
• Functional movement training
• Pain management techniques
• Rehabilitation protocols

Patient Consent

Patients must:

• Consent to RTM monitoring
• Agree to use the monitoring system/app
• Understand the service is billable

5. The 16-Minute Threshold (What Actually Counts)

Here's where most chiropractors get confused.

To bill CPT 98980 each month, you must spend at least 20 minutes of interactive time managing that patient remotely.

What Counts Toward the 20 Minutes

✅ Activities that count:

• Reviewing patient-reported exercise completion data
• Analyzing progress reports and adherence metrics
• Responding to patient messages about symptoms or concerns
• Adjusting care plans based on remote feedback
• Reviewing video submissions of exercises
• Educating patients on technique modifications
• Following up on missed exercises or setbacks
• Documenting all of the above

❌ Activities that DON'T count:

• Time spent during in-office visits (that's billed separately)
• Automated system notifications (no human interaction)
• Scheduling appointments
• Billing and administrative tasks
• General practice management

Real-World Examples

6. Documentation Requirements

Proper RTM billing requires documentation that proves:

1. The service was medically necessary
2. You spent the required time
3. The patient received therapeutic benefit

Sample Documentation Entry

Common Documentation Mistakes

❌ Vague entries: "Checked in with patient"
✅ Specific entries: "Reviewed 7-day exercise log, noted 40% adherence, messaged patient about barriers"

❌ No time tracking: "Managed care remotely"
✅ Time documented: "5 minutes reviewing data, 3 minutes responding to message"

7. Reimbursement Rates & Payer Coverage

Medicare Coverage (2026 Actual Rates)

Good news: Medicare covers RTM codes for qualified patients.

Reimbursement rates (2026 National Average):

• CPT 98975: $21.71
• CPT 98977: $51.44 (29% higher than expected!)
• CPT 98980: $54.11

Commercial Payers

Most major commercial insurers cover RTM, but policies vary:

Generally covered:

• Blue Cross Blue Shield (most plans)
• Aetna
• Cigna
• UnitedHealthcare
• Humana

8. Why Manual RTM Doesn't Scale

Here's the brutal truth about manual RTM implementation:

The math doesn't work.

The Manual RTM Workflow

To bill RTM manually, you need to:

1. Track every patient interaction (text, call, data review)
2. Log time spent on each activity
3. Calculate monthly totals per patient
4. Generate billing-compliant documentation
5. Submit claims with proper codes
6. Monitor for threshold compliance

Time required per patient per month: 20-30 minutes of administrative work.

Revenue per patient: ~$85-95

Your effective hourly rate for RTM admin: ~$100-140/hour

The Scale Problem

Let's say you want to bill RTM for 50 patients:

Manual approach:

• 20 minutes admin per patient
• 50 patients × 20 minutes = 1,000 minutes
• That's 16.6 hours per month on RTM documentation alone

9. The Automation Solution

The only way RTM scales is through automation.

What Should Be Automated

Time Tracking:

• Every patient message automatically logged with timestamp
• Data reviews tracked when you open patient reports
• Time calculated automatically
• Monthly totals flagged when threshold is hit

Documentation:

• Interactions auto-logged with date/time/activity
• Clinical notes from your review tied to RTM entries
• Billing reports generated automatically
• Compliance-ready export for claims

ROI Comparison

Manual RTM (50 patients):

• Revenue: $4,250-4,750/month
• Admin time: 16+ hours/month
• Net hourly value: ~$100/hour

Automated RTM (50 patients):

• Revenue: $4,250-4,750/month
• Admin time: 30 minutes/month
• Net hourly value: ~$5,000-6,000/hour

10. Implementation Roadmap

Ready to implement RTM in your practice? Here's the step-by-step process:

Phase 1: Preparation (Week 1-2)

• Verify payer coverage with your top 5 insurers
• Choose your technology platform
• Update patient consent forms
• Train your team on RTM workflows

Phase 2: Pilot Program (Week 3-6)

Start with 10-15 patients who:

• Have chronic conditions requiring ongoing HEP
• Are tech-comfortable (if using an app)
• Have good insurance coverage
• Visit regularly

Phase 3: Scale (Month 2-3)

Expand to 30-50 patients:

• Onboard 10-15 new patients per week
• Refine your workflow based on pilot learnings
• Automate wherever possible
• Monitor revenue vs. time investment

11. Common Mistakes to Avoid

Mistake #1: Billing Without Proper Documentation

The error: Assuming you spent enough time without tracking it.

The fix: Document every interaction with date, time, and activity. If you didn't document it, you can't bill it.

Mistake #2: Counting In-Office Time

The error: Including time spent during office visits in your RTM calculation.

The fix: Only count remote interactions. In-office time is billed via E&M or procedure codes.

Mistake #3: No Patient Consent

The error: Starting RTM monitoring without informing patients it's billable.

The fix: Get written consent explaining the service and that it will be billed to insurance.

Mistake #4: Trying to Scale Manually

The error: Attempting to bill RTM for 30+ patients using spreadsheets and manual time logs.

The fix: Invest in automation from day 1. The ROI is immediate and the alternative doesn't scale.

12. Frequently Asked Questions

Q: Can I bill RTM and E&M codes for the same patient on the same day?

A: Yes, but they must be separate services. RTM is for remote monitoring between visits. E&M is for in-office evaluation. Time spent during the office visit does NOT count toward RTM time.

Q: What if I spend 10 minutes in one month and 30 minutes the next?

A: You can't "roll over" time. Each calendar month stands alone. If you don't hit 20 minutes in a given month, you can't bill 98980 that month.

Q: Do I need special technology to bill RTM?

A: No. You can theoretically bill RTM with just text messages and manual time tracking. However, automation makes RTM practical at scale. Without it, most practices can't justify the administrative burden.

Q: How long does it take for RTM claims to be paid?

A: Typical insurance processing time: 15-45 days. Medicare is usually faster (14-30 days). If your documentation is solid, acceptance rates should be high (>90%).

Q: Are the 2026 rates permanent?

A: CMS updates rates annually. The $51.44 rate for 98977 is the 2026 national average. Geographic adjustments may vary slightly by region, but this is the baseline.