While standard RTM codes cover routine management, CPT 98981 exists for the patients who require significant, “high-touch” intervention. It is the mechanism that allows RTM to scale from simple monitoring to intensive management for complex cases.

What is CPT 98981? 

CPT 98981 is the “Add-On” code for Remote Therapeutic Monitoring Treatment Management. 

Unlike the other RTM codes, CPT 98981 cannot be billed alone. It is designed to capture each additional 20 minutes of interactive communication and treatment management services provided in a calendar month, after the initial 20 minutes has been met. 

The “Stacking” Logic: 

• Tier 1: The first 20 minutes of care = CPT 98980. 

• Tier 2: The next 20 minutes of care = CPT 98981. 

Why CPT 98981 Matters for Modern Clinics 

In a value-based care environment, the patients who need the most help are often the most expensive to manage. Before RTM, a therapist might spend 40 minutes on the phone with a struggling post-op patient and get paid $0 for that time. 

CPT 98981 solves this problem. It ensures that when you dedicate extended time to managing complications, adjusting care plans, and guiding high-risk patients, your practice is reimbursed for that expertise. It turns “high-maintenance” cases into sustainable revenue. 

The Math: When to Bill This Code 

Billing CPT 98981 requires precise time tracking. You generally need to hit a 40-minute total threshold within one calendar month to trigger this code. 

• 0–19 mins: No billing (under current 2025 rules). 

• 20–39 mins: Bill CPT 98980 (1 Unit). 

• 40+ mins: Bill CPT 98980 (1 Unit) + CPT 98981 (1 Unit). 

Note: If a complex case requires an hour of management (60 mins), you would bill 1 unit of 98980 and 2 units of 98981. 

Challenges in Implementation 

Because CPT 98981 generates higher reimbursement, it comes with higher expectations for compliance. 

1. Documentation Rigor
   You cannot simply check a box. CMSrequires proof that the additional time was medically necessary. 

• The EMBODI Solution: Our platform logs every interaction. When you use EMBODI to review data or message patients, we create a timestamped audit trail that justifies exactly when and why you went “overtime” on a patient’s care. 

2. The “Engagement” Drop-off
   It is hard to manage a patient for 40 minutes if they stop logging data after Week 1.

• The EMBODI Solution: We use automated patient engagement tools—like gamification and smart notifications—to keep patients active in the app. Higher engagement leads to more data, which leads to more billable management time. 

Best Practices for CPT 98981 

To use this code effectively without triggering audits, follow these three rules: 

1. Reserve it for High-Acuity Cases
   If you are billing CPT 98981 for every single patient, that is a red flag. Use this code for patients with:

• Post-surgical complications (e.g., stiffness, infection risk). 

• Chronic pain requiring extensive behavioral coaching. 

• Multi-trauma rehabilitation. 

2. Interactive Communication is Mandatory
   You cannot bill this code solely by looking at a dashboard. At leastsome of this time must include interactive communication (phone, video, or secure messaging) with the patient or caregiver. 
   
   
3. Document the “Pivot”
   Your clinical notes should reflect action.Don’t just say “Reviewed data.” Say “Reviewed data indicating regression in flexion; spent 15 minutes via video call correcting form and 10 minutes adjusting HEP parameters.” 

Stay Tuned: Preparing for 2026 

While CPT 98981 is the standard for complex care today, the rules for time-based billing are evolving with the new year. 

In January, we will release our full “2026 RTM Code Guide.”
We will provide a detailed breakdown of how 2026 regulations will impact documentation for these high-value add-on codes. 

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. 

Remote Therapeutic Monitoring (RTM) allows providers to collect non-physiological data—like therapy adherence, pain levels, and functional response—and use that insight to guide treatment. While the device collects the data, CPT 98980 is the code that pays for the clinician’s expertise in analyzing it. It turns “monitoring” into “management.” 

What is CPT 98981? 

CPT 98981 is the “Add-On” code for Remote Therapeutic Monitoring Treatment Management. 

It covers each additional 20 minutes of interactive communication and treatment management services provided in a calendar month. 

The Golden Rule of 98981: 

You cannot bill this code by itself. It is mathematically tied to the base code (CPT 98980). 

• First 20 Minutes: Bill CPT 98980. 

• Next 20 Minutes: Bill CPT 98981. 

Think of CPT 98981 as the “Overtime” code. It ensures that when you have a complex patient requiring significant attention, your time is still reimbursed. 

The “High-Acuity” Use Case 

Not every patient needs 40+ minutes of remote management a month. If you are using 98981 on every single patient, you are likely over-billing. This code is best reserved for High-Acuity cases where things aren’t going to plan. 

Ideal Scenarios for CPT 98981: 

• Post-Surgical Complications: Patients dealing with infection risks, scar tissue buildup, or excessive pain who need frequent video check-ins. 

• Chronic Pain Management: Patients with central sensitization who require extensive education and reassurance to maintain movement. 

• Multi-Trauma: Patients managing rehabilitation for multiple body parts simultaneously (e.g., a patient with both a rotator cuff repair and a knee replacement). 

The Math: How to Calculate the Time 

Billing CPT 98981 requires precise time tracking. You generally need to hit a 40-minute total threshold to bill this code successfully. 

• 0–19 mins: No billing (currently). 

• 20–39 mins: Bill CPT 98980 (1 Unit). 

• 40+ mins: Bill CPT 98980 (1 Unit) + CPT 98981 (1 Unit). 

Note: You can bill multiple units of 98981 if the care is extensive (e.g., 60 minutes total = 1 unit of 98980 + 2 units of 98981), though this is rare in standard outpatient practice. 

Best Practices for Compliance 

Because CPT 98981 generates higher reimbursement, it faces higher scrutiny. 

1. “Audit-Proof” Your Time Logs
   If you bill an add-on code, you must be able to prove exactly when that extra time occurred. “Estimated time” is not enough. You need timestamps showing exactly when you reviewed data and exactly how long your calls lasted.
2. Justify Medical Necessity
   Your documentation must explain whythe patient needed so much time. 

• Bad Note: “Spoke with patient for 40 minutes.” 

• Good Note: “Extended discussion required (25 mins) to address new onset of night pain and modify HEP to prevent regression. Reviewed medication adherence and coordinated with referring surgeon.” 

3. Use Technology to Track It
   Manually adding up minutes on a sticky note is a recipe for errors.

• The EMBODI Advantage: Our platform automatically aggregates your time. It knows that once you pass the 20-minute mark, the next bucket begins. It visualizes your progress toward the CPT 98981 threshold so you know exactly which high-needs patients are eligible for the add-on code. 

Stay Tuned: Preparing for 2026 

While CPT 98981 is a powerful tool for complex cases today, the regulations surrounding time-based billing are evolving. 

In January, we will release our “2026 RTM Code Guide.” 
We will break down how the new year’s changes will impact documentation standards for these high-value codes.  

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. 

Remote Therapeutic Monitoring (RTM) eliminates that guesswork, and CPT 98977 is the mechanism that pays you for it.

Think of CPT 98977 as the “subscription” code for your clinical device. It reimburses your practice for supplying the technology that tracks the patient’s musculoskeletal system.  

What CPT 98977 Actually Covers 

This code is distinct because it doesn’t pay for “time”—it pays for “data” and “technology.” Specifically, it covers the monthly supply of an FDA-cleared medical device (or software) used to monitor the musculoskeletal system. 

When you bill this, you are confirming three things occurred: 

1. Device Supply: You provided a compliant device or software (SaMD). 

1. Data Flow: The system automatically transmitted data (like range of motion or pain scores). 

1. Scheduled Monitoring: This wasn’t a one-off check; it was continuous surveillance of the patient’s condition. 

Why CPT 98977 is a Game-Changer 

For years, the Home Exercise Program (HEP) was a “loss leader”—essential for recovery, but generated $0 in revenue. CPT 98977 flips this model. 

By implementing this code, you are effectively monetizing the time patients spend in rehab at home. It turns the “black box” of home recovery into a transparent, billable data stream. This encourages therapy adherence (because patients know you are watching) and provides a steady recurring revenue stream for the practice that scales with patient volume. 

The “Four Pillars” of Billing CPT 98977 

To secure reimbursement and survive an audit, you must hit these four non-negotiable requirements: 

• The Device: It must be an FDA-cleared medical device. (A standard Fitbit or generic video app does not count). 

• The System: It must monitor the Musculoskeletal System. 

• The 16-Day Rule: The device must transmit data on at least 16 separate days within a 30-day period. 

• The Plan: The monitoring must be integrated into a therapy plan of care. 

Reimbursement Expectations 

While exact rates fluctuate by region and Medicare Administrative Contractor (MAC), CPT 98977 is generally valued between $50 and $55 per 30-day episode. Since this code relies on software automation rather than direct clinician labor, it represents one of the highest-margin opportunities in the RTM code family. 

The 3 Biggest Challenges (And How to Solve Them) 

Implementing 98977 isn’t without friction. Here is where most practices fail, and how to avoid the traps. 

1. The “Generic App” Trap (Selecting the Right Software)
   Many clinics make the mistake of using non-compliant wellness apps. Medicare is clear: the technology must meet the definition of a medical device.

• The EMBODI Difference: You cannot bill for a PDF viewer. You need Software as a Medical Device (SaMD). EMBODI is one of the few platforms that is patented and FDA-cleared specifically for this purpose. Using our platform ensures you are meeting the strict regulatory definition required for payment. 

2. The “Engagement Cliff”
   The hardest part of CPT 98977 is the 16-day requirement. If a patient gets bored and stops logging data on Day 14, you effectivelyworked for free. 

• The Solution: Stop relying on willpower. Use a platform that “gamifies” the experience and provides automated feedback to the patient. If the tech isn’t engaging, the billing won’t happen. 

3. Documentation Fatigue
   Manually counting how many days a patient logged in is an administrative nightmare.

• The Solution: Your software should do the counting for you. Automated reporting is the only way to scale this without hiring more admin staff. 

Best Practices for High-Volume RTM 

1. Use Audit-Ready Technology
   Don’t cobble together a solution. Choose a platform that automatically generates a timestamped log of every transmission. If an auditor asks, “Did this patient really engage for16 days?” your software should instantly produce the proof. 
   
2. Automate the “Nudge”
   Your clinical teamdoesn’t have time to call every patient who misses a session. Set up automated push notifications within the app. A simple reminder at 6:00 PM can be the difference between hitting 15 days (unbillable) and 16 days (billable).

3. Connect Data to Clinical Decisions
   Don’t just collect data for the sake of billing. Use the trend lines to adjust care. If CPT 98977 shows a drop in Range of Motion, bring the patient in sooner. This justifies the medical necessity of the device.

The Future of CPT 98977 

Right now, hitting that 16-day target is the only way to get paid for the supply code. But what about the patient who logs 10 days? 

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. 

The Role of RTM

Remote Therapeutic Monitoring (RTM) is transforming how clinicians manage musculoskeletal and respiratory conditions. By extending the plan of care beyond the clinic walls, RTM allows providers to collect non-physiological patient data, such as therapy adherence, pain levels, and functional response between visits.

This continuous loop of data enables proactive intervention, higher accountability, and better clinical outcomes. For practices looking to implement this model, CPT 98975 is the critical first step.

However, the RTM landscape is shifting. As of January 1, 2026, reimbursement, billing thresholds, and code families will change in meaningful ways, creating both opportunities and complexities for healthcare organizations. Below, we break down what CPT 98975 covers today, what is changing in 2026, and how your practice can prepare.

Think of this as the “activation” code for a patient’s digital episode of care. It provides reimbursement for the professional time and resources required to: 

• Set up the RTM device or FDA-cleared software application (like the EMBODI app). 

• Pair the device with the patient’s profile. 

• Educate the patient on how to use the equipment and log their data. 

Billing Frequency: This code can be billed once per episode of care. 

What’s changing in 2026—and how it affects CPT 98975 

For the past few years, there has been significant confusion regarding when this code becomes billable. Many organizations operated under the assumption that they had to wait for 16 days of monitoring to occur before they could bill for the initial setup, often leading to unbilled work if a patient dropped out early. 

The 2026 Update: The New “Two-Day” Standard

Beginning in 2026, the CPT codebook clarifies the minimum threshold. To bill CPT 98975, you must collect at least two days of RTM data within a 30-day period. 

This is a major win for scalability. By lowering the barrier to entry, CMS is confirming that RTM is not just for long-term chronic care—it is also viable for: 

• Short-term rehabilitation. 

• Post-surgical recovery. 

• Transitional care episodes. 

Case Example: Post-Op Knee Recovery 

To see how this works in practice, consider a patient recovering from a Total Knee Arthroplasty (TKA). 

The Workflow: 

1. Day 0 (In Clinic): The Physical Therapist helps the patient download the EMBODI app, sets up their specific range-of-motion goals, and teaches them how to log their daily pain scores. 
   
   
2. Day 1 & 2 (At Home): The patient goes home and logs their exercise adherence and pain levels for two consecutive days.

    

3. The Result: Because the patient has successfully transmitted data for two days, the clinic has met the requirement to bill CPT 98975 immediately. They do not need to wait for the full month to pass to be reimbursed for the setup and education time. 

Stay Tuned: The Full 2026 Playbook is Coming in January 

While the “Two-Day Rule” simplifies activation, it introduces new tracking requirements. You need to know exactly when that second day of data hits your system to ensure timely billing. 

Stay tuned for our complete “2026 RTM Code Guide,” launching in January.