Most clinics that look at Remote Therapeutic Monitoring stall in the same place, and it is not the clinical question. It is which of my payers will actually pay for this? An RTM consultant we spoke with, who ran an RTM program in house for a 13 therapist practice, put the problem this way:
"Am I just cherry-picking Medicare because they're the only ones that pay? Do I do it for all my patients and expect not to get paid on some of them? So there is some administration burden up front where you've got to check the authorization for what these insurances cover, insurance by insurance, almost case by case while you're getting started. And that burden upfront is enough of a risk."
He does this professionally, and he did not have the answer. Neither does anyone else we could find. So we went and read the policies.
This page is a summary of published payer documents. It is not coverage advice, it is not a guarantee of payment, and it cannot tell you whether one specific patient's claim will pay. Section 4 explains exactly why not, and that limitation is the single most useful thing on this page.
Contents
1. The codes in scope
2. What each payer's policy says
3. Medicaid and workers' compensation
4. Why this is hard, and why nobody publishes it
5. How to verify for your own patient
6. What is changing
7. Method, gaps, and corrections
1. The codes in scope
RTM is two families of codes measured over two different windows, which is itself a common source of billing error.
Device supply, measured over a rolling 30 day period: 98975 (setup and patient education, once per episode of care), 98977 (musculoskeletal, 16 or more days of data), 98985 (musculoskeletal, 2 to 15 days of data, new for 2026). Respiratory and cognitive behavioral equivalents exist as 98976/98978 and 98984/98986.
Treatment management, measured over a calendar month and requiring at least one real-time interactive communication: 98979 (first 10 minutes, new for 2026), 98980 (first 20 minutes), 98981 (each additional 20 minutes).
The codes are not additive. One device supply code per 30 day period, one base management code per month. Only one practitioner may bill RTM for a given patient in a given period, and the practice is expected to designate who.
2. What each payer's policy says
Every row below was read from the named document on the date shown. Where we could not find a policy, the row says so rather than guessing.
| Payer | Position | What the document says |
|---|---|---|
| MedicareTraditional fee-for-service, Part B | Covered PRIMARY SOURCE |
Physical therapists are explicitly permitted to bill RTM. CMS initially proposed barring PTs on an "incident to" theory and reversed in the CY2022 final rule. Services must be furnished under an active plan of care during the episode of care, and patients may self-report and manually enter data. APTA Practice Advisory, RTM Codes Under Medicare · CMS Transmittal R11118CP Read August 27, 2026 |
| Medicare AdvantagePart C, all carriers | Covered with criteria UNVERIFIED |
MA plans must cover Part B benefits, so RTM is covered in principle. But there is no National Coverage Determination for RTM, and that absence is precisely the condition under which CMS permits an MA plan to apply its own internal coverage criteria. Roughly 99% of MA enrollees are in plans that require prior authorization for some services.
The useful part: since April 2026 CMS requires MA organizations to publish those internal criteria publicly, free of charge, and without creating an account. So if your patient's MA plan has extra RTM criteria, that document is now something you can demand to see. "The patient has Medicare" is not a sufficient answer if the patient is in MA, and roughly half of Medicare enrollees are. KFF, Medicare Advantage in 2026 Read August 28, 2026 · determined per MA plan, no single policy |
| CignaCommercial | Not covered PRIMARY SOURCE |
Verbatim from Coverage Policy 0563: "Remote Therapeutic Monitoring (RTM) (CPT codes 98975, 98976, 98977, 98978, 98979, 98980, 98981, 98984, 98985, 98986) is not covered or reimbursable for ANY indication." All ten codes also appear in the policy's "Not Covered or Reimbursable" table. This is a categorical exclusion, not a criteria based restriction. Cigna Medical Coverage Policy 0563 Policy effective May 15, 2026 · read August 27, 2026 |
| Elevance Health (Anthem)Commercial. Anthem Blue plans in 14 states: CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI | Covered with criteria PRIMARY SOURCE |
Medically necessary when the clinical record documents all of: clinically appropriate per accepted standards; data regularly assessed to detect acute changes and prompt intervention; not primarily for convenience; patient at risk of clinically significant change warranting enhanced monitoring; patient unable to access regularly scheduled outpatient care, or monitoring required between visits; and monitoring reasonably likely to prevent avoidable deterioration. Not medically necessary where similar services are provided concurrently, home health being the example given. Anthem Clinical UM Guideline CG-MED-91 Published December 18, 2025 · read August 27, 2026 |
| Aetna (CVS Health)Commercial | No policy found PRIMARY SOURCE |
Aetna's Clinical Policy Bulletin 1093 is frequently cited as an RTM policy. It is not. Its stated scope is "remote physiologic monitoring (RPM) services," and it makes no coverage determination on RTM at all. The RTM codes appear only under "Other CPT codes related to the CPB," a reference list. We found no separate Aetna RTM bulletin. Worth knowing for context: Aetna's RPM policy covers only heart failure, hypertension and diabetes, and expressly excludes "data collected manually by the patient and not automatically transmitted." Aetna Clinical Policy Bulletin 1093 Last reviewed May 31, 2026 · read August 27, 2026 |
| UnitedHealthcareCommercial and Medicare Advantage | No policy found PRIMARY SOURCE |
UHC's own January 2026 Medical Policy Update Bulletins, both commercial (49 pages) and Medicare Advantage, contain zero mentions of the RTM codes or the phrase "remote therapeutic." No UHC RTM policy exists that we could find.
Correcting a widely repeated claim: UHC's remote-monitoring withdrawal is frequently reported as effective January 2026. It was not. Both bulletins say verbatim: "The Medical Policy titled Remote Physiologic Monitoring (RPM) will not be effective on Jan. 1, 2026, as previously announced; implementation of the new policy has been postponed until further notice." It was delayed after provider and medical-society pushback. UHC says it still intends to implement during 2026 with advance notice of a new date. That action concerns physiologic monitoring and does not name the RTM codes. UHC Commercial Medical Policy Update Bulletin, January 2026 · the Medicare Advantage bulletin Read August 28, 2026 |
| HumanaCommercial and Medicare Advantage | No policy found UNVERIFIED |
A good-faith search found no published Humana RTM coverage policy. Absence of a located policy is not evidence of coverage or non-coverage. Verify directly. Searched August 27, 2026 |
| BCBS of Michigan / Blue Care NetworkCommercial, incl. self-funded groups unless otherwise specified | Covered PRIMARY SOURCE |
RTM for a respiratory or musculoskeletal treatment plan is "considered established when criteria are met," with 98975, 98976, 98977, 98980 and 98981 listed as established codes. Requires a written order specifying the condition and the length of time, up to 90 days. Data "may be self-reported by the individual or may be electronically captured by a device." RTM "is not intended to be an ongoing modality." The software or device itself is generally not separately covered. BCBSM/BCN Joint Medical Policy, Remote Therapeutic Monitoring Policy effective March 1, 2023 · read August 27, 2026. Caution: the document lists its own next review as Q4 2023 and may have been superseded. |
| HighmarkCommercial. PA, WV, NY | Covered with criteria PRIMARY SOURCE |
Medically necessary with criteria, and the authorized provider list explicitly names Physical Therapist (PT) alongside OT, SLP, MD, DO, NP, PA and others. Treatment plan must be respiratory, musculoskeletal or cognitive. Initial authorization is 3 months, renewable in 3-month blocks on documented ongoing measurable improvement. Setup and supply limited to once per 30 days, 6 per calendar year.
⚠ The one criterion most likely to catch a software vendor: "All technology utilized has been authorized by the FDA, either through approval, clearance, or emergency use authorization." Note the tension inside the same document, which defines RTM data as "typically self-reported." If your platform is not FDA cleared, ask Highmark how they apply this before you bill. Highmark Medical Policy M-89-001 Effective November 24, 2025 · read August 28, 2026 |
| Blue Cross Blue Shield of North CarolinaCommercial | Covered with criteria PRIMARY SOURCE |
Verbatim: "BCBSNC will provide coverage for Remote Therapeutic and Physiologic Monitoring when it is determined to be medically necessary because the medical criteria and guidelines shown below are met." The 2026 codes were added effective January 1, 2026. Criteria mirror the Anthem pattern, including "unable to access regularly scheduled outpatient care." Does not specifically name physical therapists, referring instead to "physician or other qualified healthcare professional." Its own caution: "Inclusion of a code in this section does not guarantee that it will be reimbursed." Blue Cross NC, Remote Therapeutic and Physiologic Monitoring Effective April 18, 2023, last reviewed February 2026 · read August 28, 2026 |
| All other Blue Cross Blue Shield plansRemaining independent licensees | Not researched UNVERIFIED |
"Blue Cross" is not one payer. It is 33 or more independently operated licensees, each publishing its own medical policy, and a determination by one licensee binds no other. The clearest proof is inside the register itself: Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of Illinois are the same parent company, HCSC, and were recorded with opposite RTM positions. Idaho has two Blues and they disagree too.
The coverage lookup now carries every Blue licensee we could name, plus all 50 state Medicaid programs. Many are marked "no policy found," which is an honest answer and not a coverage determination. Search your own plan there. Known gap, August 28, 2026 |
Two of the largest national carriers reach opposite conclusions on the same code set. Cigna excludes all ten codes categorically. Anthem covers them subject to six documented criteria. There is no national "commercial payers are coming around" trend to report, and any guide that reports one has not read the documents.
3. Medicaid and workers' compensation
Medicaid varies by state and we have not independently verified it. APTA's State Medicaid Payment Rate Guide reports 25 states as possibly reimbursing RTM: Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Rhode Island, Utah, Virginia and Wyoming. That guide is available to APTA members only, so we are reporting it secondhand and it carries an UNVERIFIED label for that reason.
Two cautions on that list. First, RTM coverage is materially narrower than RPM coverage, and the two are often conflated: roughly 41 state Medicaid programs reimburse RPM, which is a different question about different codes. Second, individual state Medicaid fee schedules are public and are the authoritative check. If your Medicaid population matters to the decision, look up your own state's schedule rather than relying on this list.
Workers' compensation is not covered by this guide at all. It runs on state-specific fee schedules and rules entirely separate from group health. It is a real part of most outpatient PT payer mixes, and its absence here is a known gap rather than an oversight.
4. Why this is hard, and why nobody publishes it
A carrier's medical policy is not the binding document for most commercially insured patients
About 67% of covered workers are in self-funded employer plans. In those, the employer carries the risk and the carrier only administers the plan. The employer's plan document governs, and it can differ from the carrier's published policy.
You do not have to take our word for it, because the carriers say so themselves. From Cigna's own instructions for use:
"In the event of a conflict, a customer's benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document."
BCBS of Michigan puts it more bluntly at the top of its policy: "These documents are not to be used to determine benefits or reimbursement."
So a perfect carrier-level table, which this is not, still could not tell you whether a given claim will pay. It narrows the question. It does not close it.
The easily available answers are wrong
Search this question and you will find confident secondary summaries stating that Aetna, UnitedHealthcare, Cigna and most Blue plans have published RTM coverage policies. We checked each against the primary document. Cigna's policy is a categorical exclusion. Aetna's cited bulletin is about RPM and makes no RTM determination. On the same search, a second aggregator asserted the opposite of the first about Aetna. Neither traced to a document.
This matters because the error runs in the expensive direction. A clinic that enrolls twenty patients on the strength of a wrong "covered" entry eats twenty denials.
Coverage is contracting, not expanding
The prevailing narrative is that commercial payers are gradually adopting RTM. The clearest primary evidence points the other way. Cigna excludes all ten RTM codes categorically for any indication. UnitedHealthcare announced it would withdraw remote physiologic monitoring coverage across commercial and Medicare Advantage, citing insufficient evidence of efficacy, and although that withdrawal has been postponed rather than implemented, the stated intent to withdraw stands. Meanwhile two payers have attached FDA technology requirements that most RTM software would not meet.
Any snapshot of this landscape decays, which is why every row here carries the date we read it, and why we would rather show you the document than summarize it.
A criterion below the coverage decision: does the platform have to be an FDA-authorized device?
Some payers attach a technology requirement to RTM on top of the clinical criteria. It is easy to miss because it sits underneath the coverage decision, and it can defeat a claim that satisfies every clinical criterion.
Highmark requires that "all technology utilized has been authorized by the FDA, either through approval, clearance, or emergency use authorization." Blue Cross of Idaho goes further in a policy effective August 2026: data must be "generated by a medical device or approved digital therapeutic platform," and it explicitly excludes monitoring via "phone calls, texting, or manual logs" as well as non-FDA-compliant software.
That sits awkwardly against how the codes are usually described, and against other payers. Blue Cross Blue Shield of Michigan says the opposite outright: "The use of a device is not required. If a platform is able to track data from an individual (eg, software, a wearable, self-reported information), remote therapeutic monitoring is achieved." Highmark's own policy defines RTM data as "typically self-reported" in the same document that demands FDA authorization. That is an unresolved tension inside a single policy, not just across the market.
One distinction that gets conflated and matters: "meets the FDA definition of a device" is not the same as "FDA cleared." Software can be a device and still be exempt or fall under enforcement discretion, and separately the 21st Century Cures Act excluded some software functions from the device definition entirely. Highmark's wording asks for clearance, approval or an EUA, which is the highest of those bars. Most RTM software is not cleared.
What to do about it: ask your payer in writing whether your platform satisfies their technology criterion before you bill, and ask your vendor what its FDA status actually is. For the record, since we build one of these: Rehabity is not an FDA-cleared device. We would rather say so on our own page than have you find out in a denial.
There is no API that answers this
A reasonable instinct is to check eligibility electronically. Eligibility clearinghouses return benefit eligibility, not per-CPT coverage policy. They will tell you the patient is active and what their deductible is. They will not tell you whether the plan pays 98977. That gap is why this remains manual research, and why nobody has published the map.
5. How to verify for your own patient
Given all of the above, here is the practical sequence. It is not glamorous and there is no shortcut.
- Establish the line of business first, not the carrier. Medicare fee-for-service, Medicare Advantage, Medicaid, commercial fully insured, commercial self-funded, or workers' comp. This single question determines which document governs, and it is the step most often skipped. A card reading "Aetna" tells you almost nothing on its own.
- For traditional Medicare, you are on solid published ground. Confirm the plan of care is active and that your documentation will show the review actually happened.
- For everything else, call the payer and ask specifically whether the RTM CPT codes you intend to bill are covered for this plan, when billed by a physical therapist. Name the codes. Coverage of RPM does not imply coverage of RTM, and this is the most common way the question gets answered wrongly.
- Record the answer where your whole clinic can see it: date, representative, reference number, and the exact codes discussed. Most of the pain here is not the first call, it is the fourth therapist making the same call about the same plan because nobody wrote the answer down.
- Re-check when the plan year turns. Policies change with limited notice, and January is when it happens.
- Track what actually adjudicates. A paid claim and a denial are better evidence than any policy PDF, including this page. Over a year, your own remittance history becomes the most accurate coverage map you will ever have for your specific payer mix.
6. What is changing
Two items are live as of August 2026. Both are proposals, not rules, and should not be planned around as settled.
- The CMS CY2027 proposed rule would restrict third-party and outsourced monitoring arrangements. Vendors built around that model are expected to comment against it.
- The same proposed rule contemplates bundling the RTM codes, which are currently billed separately.
On the settled side, January 2026 added 98979 (treatment management, first 10 minutes) and the 2 to 15 day device supply codes 98984, 98985 and 98986, which give shorter monitoring periods a billable path that did not previously exist.
7. Method, gaps, and corrections
How we built this. We read each payer's own published policy and recorded the position, the policy identifier, the effective and review dates, and the operative sentence. Where no primary document could be found after a good-faith search, the row says "no policy found" and is labelled unverified. We do not generalize from one corporate entity to a related one.
What is missing. Workers' compensation entirely. Independent verification of most state Medicaid programs against their own fee schedules, which are public and are the authoritative source: our state rows report what APTA's member-only guide lists and are labelled unverified for that reason. A written RTM position from Humana, UnitedHealthcare, Kaiser and a long tail of Blue licensees, where a good-faith search found nothing to read. And a number of rows drawn from the AMA's commercial-payer survey, which was last updated August 2023 and is therefore a dated indication rather than a current determination. Every one of those is labelled on the page. We would rather name a gap than fill it with inference.
Corrections are genuinely welcome. If you have a policy document that contradicts a row here, or a remittance that shows a payer behaving differently from its published policy, please send it to contact@rehabityhealth.com. Real adjudication data beats a policy PDF and we will update the page and credit the correction.
Rehabity builds home exercise and remote therapeutic monitoring software for outpatient physical therapy clinics. We wrote this because we needed the answer ourselves and could not find it anywhere. If it is useful, you are welcome to cite it. If you want to see what we build, join the waitlist or read about the therapist side. Nothing on this page is gated.