Step 1
Give RTM an owner
RTM is a lot of small, recurring jobs: enrolling patients and getting consent, checking the data, making the monthly call, logging time, and putting the billing documentation together at the end of the month. When those jobs belong to every therapist, they belong to nobody. In our conversations, that was the most common reason RTM stalled. The software was rarely the problem. Nobody owning the work was.
The clinics where RTM works designate one person to run it, or a few in a larger practice. Often that is a PT who also manages the office, or a PTA. They enroll patients, review the data, make the calls and own the documentation. One RTM billing consultant we spoke with put it plainly: once a practice has more than two clinicians, a designated RTM champion is the way to go.
Everyone else changes nothing
Treating therapists keep building and assigning home programs exactly as they do now. The only habit worth adding is saving those programs to a shared clinic library rather than keeping them in one person's head or drawer, so the RTM lead can see them and adjust them. Nobody else has to learn RTM billing.
One owner per patient
Medicare lets only one practitioner bill a patient's RTM in a given period, and the time you bill has to be the billing practitioner's. So give every RTM patient exactly one owner. In a bigger clinic, split patients between two or three RTM leads by caseload or location instead of sharing patients between them. That keeps each patient's time log matched to the person who bills it.
Step 2
Use the data to screen, not to sweep
The trap is treating RTM like a checklist: open every chart, call every patient, give everyone the same twenty minutes. That spends your RTM lead's week on patients who were doing fine all along.
Use what patients report as a screen instead. When patients log their pain, how hard the session felt and a note after each session, and rate the everyday activities they care about once a week, most of your caseload sorts itself. The data shows they are on track and a short review confirms it. Your time goes to the handful whose data says something changed.
On track
What you see
Logging regularly. Pain steady or falling. Function holding or improving.
What to do
A quick review, the monthly check-in call, and move on.
Usually adds up to
The 10-minute level.
Needs attention
What you see
Logging slipping. Pain creeping up on one exercise. Function flat for a few weeks.
What to do
A real conversation. Ask what's getting in the way and adjust the program.
Usually adds up to
The 20-minute level.
At risk
What you see
Stopped logging. Pain spiking. Function dropping.
What to do
Call soon, change the program, and decide whether they need to be seen.
Usually adds up to
Often a visit, not more monitoring. See step 4.
The code always follows the minutes you actually spent and documented, never the color of the dot.
Watch function, not only pain
A patient can report the same pain week after week while doing more and more. A function measure such as the Patient-Specific Functional Scale (PSFS), where the patient names a few activities they struggle with and rates each one weekly, shows whether they are getting better at the things they actually care about. A change of about 2 points is the threshold commonly used to call it meaningful.
Step 3
Match the minutes to the patient
RTM treatment management is billed on the time your team spends on a patient in a calendar month, and every level needs at least one real-time, interactive conversation with the patient that month. In 2026 there are three codes:
| Code | Time in the month | PT denial rate, 2025 |
|---|---|---|
98979 | 10 to 19 minutesNew in 2026 | no claims data yet |
98980 | The first 20 minutes | about 9% |
98981 | Each additional full 20 minutesAdded on top of 98980 | at least 43% |
Denied services as a share of submitted services, physical therapists in private practice, traditional Medicare, calendar 2025. "At least" because CMS hides small counts. National averages across every reason a claim can be denied, not your odds. 98979 and 98980 are never billed for the same patient in the same month.
98981 stands out. At least 43% of physical therapists' claims for it were denied in 2025, up from about 10% in 2023, while the first-20-minute code was denied about 9% of the time. CMS doesn't publish the reasons. But it is a clear sign the extra-time code gets looked at closely.
What that means day to day
- Stable patients: when the review and the monthly call take ten to nineteen minutes, that's 98979. Don't stretch a patient who is doing well to twenty minutes to reach a higher code.
- Flagged patients: put your twenty-minute conversations where the data says they're needed. That's 98980.
- 98981 only when it really happened: a patient who genuinely needed another full twenty minutes, with a time log that supports every one of them. If the same patient keeps needing it, that usually means they need a visit, not more monitoring.
Step 4
Turn what you find into action
Monitoring only matters if something changes because of it. There are two moves.
Adjust the program the same day
If one exercise keeps spiking pain, drop it or swap it. If everything feels easy, add load. If they keep missing a day, change the frequency. Making that change between visits means a patient who is only seen every two to four weeks isn't stuck on a plan that stopped fitting.
Bring them in when they need it
Some flags aren't solved by a program change. When a patient is struggling, schedule a visit, in person or by telehealth where the payer covers it, billed as normal treatment. RTM finds the patient. The visit treats them. Keep the two separate in your records: minutes spent in a visit don't also count toward RTM management time.
Used this way, RTM is more than a monthly payment. It points your clinicians at the patients who need them, so problems surface between visits instead of at the next one.
Where RTM pays off most
RTM matters most when there is a long gap between visits. A patient you see three times a week leaves little to monitor. These are the three groups where it earns its keep:
Patients tapering off
Near the end of an episode visits drop to every two to four weeks. That's when patients are most on their own and when a program that stopped fitting goes unnoticed.
Long-term and chronic conditions
Patients managed over months, where small shifts in pain or function decide when to change the plan.
Patients who can't come in often
Distance, transport, work or caregiving. RTM keeps you connected between the visits they can make.
~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 exactly when patients are most on their own.
73,494 device-supply services vs 64,893 setups. CMS Physician/Supplier Procedure Summary, 2025.
Same rate
for 2 to 15 days of data (98985) as for 16 or more (98977) in 2026. A patient who logs on some days, not most, still counts for the device payment.
CMS 2026 Physician Fee Schedule relative value file (RVU26C).
So keep patients on RTM through the taper. RTM is billed under an active plan of care, so this means the low-visit stretch at the end of an episode, not after discharge.
What a week looks like for your RTM lead
- Every dayScan for new red flags: a pain spike, a patient who stopped logging, a message that needs an answer.
- Every weekWork through the amber and red patients. Make the calls, note what each one covered, adjust programs, and tell the treating therapist about anyone who should be seen.
- Every monthMake sure every patient you plan to bill has had their live conversation, and give the green patients their short review.
- Month endProduce each patient's documentation, upload it to your EMR, and bill the codes the days and minutes actually support.
- New patientsGet consent, including that they may owe cost sharing, and show them how to log. That setup and education is its own code (98975), billed once per episode.
How Rehabity is set up for this
We built Rehabity around this workflow instead of adding RTM on top of a home exercise tool.
- Your clinic admin designates the RTM therapists. Everyone else builds and assigns programs from a shared clinic library and never has to touch billing.
- Patients log pain, effort and a note after each session in the app or on the web, and rate their own three PSFS activities every week.
- Every patient shows as On Track, Needs Attention or At Risk, and a PSFS change is only highlighted once it passes the 2-point threshold.
- Review time is logged while you work in a chart, and every live call is recorded with a note of what it covered.
- At month end you get a signed documentation packet for each patient, ready to upload into your EMR. You bill the codes yourself, so you always know what went out.
- You pay per RTM therapist, not per patient. Keeping RTM with one or a few people keeps your bill flat as you enroll more patients.
See the workflow with your own caseload in mind.
We'll walk through how your RTM lead would enroll, review and bill, and how the rest of your team keeps working the way they do today.
Keep going
- RTM revenue and time calculator: what RTM would bring in for your clinic, how many hours it takes, and your denial exposure.
- Which insurers actually cover RTM? A sourced breakdown of each major payer's published policy.
Sources: CMS Physician/Supplier Procedure Summary 2023 and 2025 (provider specialty 65, physical therapist in private practice); CMS 2026 Physician Fee Schedule relative value file RVU26C; Stratford et al. 1995, Physiotherapy Canada, on the PSFS. The workflow recommendations come from our 2026 conversations with clinic owners, RTM billing consultants and RTM researchers. Spot something that doesn't match your experience? Tell us at contact@rehabityhealth.com.