1 · Your team and caseload
Medicare adjusts every rate by locality.
Your RTM lead, plus anyone who helps. Their time is pooled.
Traditional Medicare patients who qualify and would agree, at any one time. The plan never covers more than this.
CMS DATA In 2025, PTs in private practice billed about 1.1 months of device supply per RTM enrollment.
2 · Each month a patient is on RTM
Needed to bill device supply. New in 2026: 2 to 15 days (98985) pays the same as 16 or more (98977), so the old 16-day cliff no longer costs device revenue. ASSUMPTION
Every treatment management code needs at least one real-time interactive communication in the calendar month. ASSUMPTION
Not a time-based code, but it is real staff time. ASSUMPTION
Billing counts time in fixed steps, and real work runs over: checking logs between calls, answering messages, and patients who never reach a billable threshold. Enter 0 to see only the billable minimum. ASSUMPTION
3 · Payment and costs
Medicare pays 80% of the allowed amount, less 2% sequestration. The other 20% is billed to the patient or their supplemental plan. ASSUMPTION
Optional. Leave at 0 to see revenue before staff time. Include benefits if you enter it.
Optional. Whatever you pay or have been quoted, from any vendor.
Most RTM revenue from your time
$0
per month
Net after your costs
$0
per month
Patients your team can cover
0
at once
Revenue per staff hour
$0
before staff cost
Where to spend the time
| Management per patient a month | Patients | Revenue / mo | Per staff hour | Denied / mo |
|---|
Each row gives every covered patient the same management time, using all your staff time up to your eligible patients. The plan above picks the best mix, highlighted. Most likely case.
Where the money comes from, per month
| Code | Claims | Rate | Denied | Expected |
|---|
Rate is the 2026 Medicare allowed amount for your locality (non-facility, non-QP conversion factor $33.4009). Expected is what you would collect after Medicare's 80% less sequestration, the share of coinsurance you collect, and denials. Claims are monthly averages at a steady number of patients, for the recommended plan in the most likely case.
How long patients stay on RTM
| Months per patient | Patients | New / mo | Revenue / mo | Per patient stay |
|---|
Denial exposure
| Code | PT denial rate, 2025 |
|---|---|
98975Setup and patient education | at least 9.0% |
98977Device supply, 16 to 30 days | at least 13.0% |
98980Management, first 20 minutes | at least 8.8% |
98981Management, each extra 20 minutes | at least 42.7% |
98979 / 98985New in 2026, no claims data yet | assumed same as 98980 / 98977 |
97110Therapeutic exercise, for comparison | at least 4.0% |
Denied services as a share of submitted services, physical therapists in private practice, traditional Medicare, calendar 2025. "At least" because CMS hides small counts. These are national averages across every reason a claim can be denied. They are not your odds.
What Medicare's own data says about RTM in PT clinics
We analyzed CMS's public claims files for 2022 through 2025. Three findings matter for anyone setting up RTM.
~1.1 months
of device supply billed per RTM enrollment by PTs in private practice in 2025. RTM usually stops when visits stop, which is when patients are most on their own.
73,494 device-supply services vs 64,893 setups. CMS Physician/Supplier Procedure Summary, 2025.
43%+
of PT claims for the extra-20-minute management code were denied in 2025, up from about 10% in 2023. The first-20-minute code was denied at about 9%.
CMS Physician/Supplier Procedure Summary, 2023 and 2025, provider specialty 65.
Same rate
for 2 to 15 days of data (98985) as for 16 or more (98977) in 2026: $51.44 nationally. A patient who logs 10 days no longer costs you the device payment.
CMS 2026 Physician Fee Schedule relative value file, July release (RVU26C). Both codes 1.54 RVUs.
Before you bill: what claims are checked for
The documentation below is what an auditor or a denial will turn on. Check each against your payer and Medicare Administrative Contractor. This is a checklist, not billing advice.
- Consent on file before you bill, with a note that the patient understands they may owe cost sharing.
- Setup and patient education documented (98975), billed once per episode of care.
- One practitioner per 30-day period for device supply. Only one can bill a patient's device codes in a period.
- A real-time interactive communication every month you bill management, with its date and what it covered.
- A time log that supports every increment. 98981 needs each full extra 20 minutes, and 98979 and 98980 are never billed in the same month.
- A plan of care, and the GP modifier when a physical therapist bills the codes.
How this is calculated
Every step is shown so your billing team can check it.
- Staff time per month = people × hours a week each × 4.33 weeks.
- One patient for one month at a given management level takes: setup minutes ÷ months per stay, plus management minutes × the share of months with data and a live call, plus extra review minutes × 4.33. It earns: a setup claim (98975) ÷ months per stay, a device claim (98985 or 98977) × the share of months with at least 2 days of data, and the management claims × the share with data and a live call.
- The plan is the mix of management levels (10, 20, 40 or 60 minutes) that earns the most expected revenue, after denials, within your staff time and your eligible patients. It is a small linear program, so the best plan never mixes more than two levels. Treatment management is always included: device supply billed without it is the "missing components" pattern the HHS Inspector General flagged in remote monitoring.
- New enrollments per month = patients covered ÷ months per stay.
- Rate = (work RVU × work GPCI + practice expense RVU × PE GPCI + malpractice RVU × MP GPCI) × $33.4009, from the CMS 2026 July release for your locality.
- Expected = rate × (80% × 98% + 20% × your coinsurance collection) × (1 − denial rate).
- Revenue per staff hour = revenue ÷ staff hours the plan uses.
- The range. Low case: 20 points fewer months with 2+ days of data and with a live call, denials at 1.5× the national PT rate, and no coinsurance collected. High case: 10 points more of each (up to 100%), denials at half the national rate, and all coinsurance collected. The most likely case uses your inputs exactly.
What it leaves out
Medicare Advantage, Medicaid and commercial plans set their own rates and coverage rules, and some do not cover RTM at all. Check yours in our RTM coverage lookup. The Part B deductible is ignored, since most patients meet it through their visits. Physician-billed RTM, facility rates and the 2026 qualifying-APM conversion factor are not modeled.
Sources: CMS 2026 PFS relative value file RVU26C and GPCI Addendum E (released June 30, 2026); CMS Physician/Supplier Procedure Summary 2023 and 2025; CMS Medicare Physician & Other Practitioners by Provider and Service, 2024. Found a figure that does not match your remittances? Tell us at contact@rehabityhealth.com and we will correct the page.
Most of the revenue is in the months after the last visit.
Rehabity is built around one designated RTM lead per clinic: every therapist keeps building home programs, patients log how each session went, and your RTM lead reviews it and adjusts the program the same day. Pricing is per RTM lead, not per patient.