Talk with us CARE PROGRAM GUIDE · RTM
Remote Therapeutic Monitoring
The care team checks how a treatment is going at home—for example, whether a patient can follow a therapy plan and whether movement is improving.
CMS finalized new initiating-visit and valuation rules for RPM and RTM, and an established-patient requirement for RTM. The direct-employee requirement for monitoring clinical staff starts in 2029. Current rate examples below remain 2026 references.
See what changes and when →FIRST, THE SHORT ANSWER
What would RTM add to care?
RTM uses qualifying connected medical-device technology to collect non-physiologic therapeutic information, such as treatment adherence or response. Patient-entered data may qualify when collected and transmitted through the appropriate device workflow; an ordinary app or phone call is not automatically RTM.
A qualifying RTM medical-device pathway may be hardware or suitable software that meets the applicable medical-device and code requirements. Unlike RPM, patient self-reported therapeutic data may be used. A generic app, text reminder, survey, or phone call is not automatically a billable RTM device.
PATIENT & PRACTICE FIT
Could this help people you treat?
Potential fit
A treating practitioner identifies a therapy-related clinical need, a qualified RTM device or software workflow and plan are available, and the patient can participate in meaningful monitoring between visits.
Check before enrolling
No responsible treating practitioner; no qualifying device workflow for device-supply billing; generic reminders or dispensing calls alone; unclear therapy-plan, supervision, payer, or patient-cost rules.
PATIENT EXPERIENCE
The patient uses the agreed therapeutic monitoring tool, reports or transmits treatment information, and receives purposeful follow-up when adherence, symptoms, or function suggest the plan needs review.
SEE IT IN PRACTICE
Care between visits, step by step.
Meet Elena: her therapist wants to understand how her prescribed home rehabilitation plan is going between visits.
The goal: Help Elena follow her treatment and identify when the therapist needs to review it.
Choose a stage to see what the patient, treating practice, and PrimeVital’s agreed team each do.
Choose the pathway
Before enrollment- Patient / caregiver
- Discusses treatment goals, participation, and costs.
- Treating practice
- Confirms the treating professional, therapy scope, and suitable clinical domain.
- PrimeVital’s agreed role
- Helps map onboarding, technology, and documentation needs.
- What gets recorded
- Medical need, payer, professional eligibility, and plan of care where required.
Illustrative scenario, not a patient record or clinical protocol. Clinical targets, review frequency, staff qualifications, escalation, and service hours are agreed with the treating practice. Clinical decisions stay with qualified personnel.
SAMPLE CARE PLAN
A plan the patient and the team can understand.
Help Elena follow her treatment and identify when the therapist needs to review it.
- Patient task
- Use the agreed monitoring tool to record adherence and response to the prescribed plan.
- Clinical owner
- The treating therapist selects appropriate measures and adjusts the therapy plan.
- Team follow-up
- Help with the tool and route adherence, function, or symptom concerns to the therapist.
- Review
- Compare participation and the therapist-selected functional measure at the next review.
After launch: the continuing period
Continue only while therapeutic monitoring serves the treatment plan. Initial setup is separate from recurring supply and management. Generic exercise videos, reminders, or phone calls do not establish an RTM device service.
YOUR INVOLVEMENT
Clinical ownership stays with the treating practice.
The agreement names the people, work, coverage hours, records access, and handoffs. Technology and operational support do not transfer clinical or billing authority.
What your clinician does
An eligible physician or nonphysician practitioner, or a qualified therapist (PT, OT, or SLP where the code and therapy scope apply), may be the Medicare Part B billing professional. Enrollment, code, plan of care, setting, and state scope determine the actual route.
What supporting staff can do
Eligible clinical or auxiliary personnel may contribute under the applicable practitioner, supervision, and code rules. A pharmacist working in an eligible practice may have a support role, but pharmacist participation or ownership of an independent pharmacy does not itself confer a Part B RTM billing right.
What we can organize with you
PrimeVital can scope onboarding, technology coordination, patient outreach, documentation, task routing, and billing handoffs within an agreed arrangement. The treating organization keeps clinical authority and the final claim decision.
PrimeVital’s full care arrangement includes applicable devices and a care-management team. The program determines which resources and professional qualifications are needed. Interactly can support front-desk tasks within the agreed scope; 24/7 PrimeVital clinical coverage is not assumed.
REQUIREMENTS BEFORE LAUNCH
Make the pathway ready before enrolling patients.
- Identify the treating professional and clinical treatment plan, not just a technology vendor.
- Confirm the device or software qualifies for the proposed clinical-domain code.
- Track actual data days separately from management time and interactive communication.
- Verify therapy plan-of-care and modifier rules, assistant supervision, independent-pharmacy limits, payer coverage, and no concurrent RPM.
Detailed operating workflow and technology
- 1
Select
Define the treatment goal, billing professional, payer, consent, and clinical plan.
- 2
Connect
Verify qualifying technology, set it up, teach the patient, and check data access.
- 3
Respond
Review treatment data, contact the patient as clinically useful, and return decisions to the treating team.
- 4
Validate
Reconcile data days, distinct management time, interactive communication, documentation, and the claim.
Technology and records: A qualifying RTM medical-device pathway may be hardware or suitable software that meets the applicable medical-device and code requirements. Unlike RPM, patient self-reported therapeutic data may be used. A generic app, text reminder, survey, or phone call is not automatically a billable RTM device.
GETTING PAID
Who receives payment, and what earns it?
Care need, completed services, evidence, and the actual payer determine the claim. A covered service or an enrollment is not the same as collected revenue.
The eligible physician, nonphysician practitioner, or qualified therapist bills the applicable pathway. A support vendor, independent pharmacy, chiropractor, or acupuncturist does not gain Medicare RTM billing eligibility just by using an app. PrimeVital is paid through its agreement.
Medicare Part B recognizes RTM when the billing professional, medical necessity, technology, code-specific work, and documentation requirements are met. Device-supply and management codes have separate tests.
For Medicare Advantage, Medicaid/Medi-Cal, and commercial coverage, verify the member, network, delegated entity, device policy, authorization, contract, and provider-type rules. The presence of a CPT code is not a payment promise.
Original Medicare Part B deductible and coinsurance may apply; supplemental or plan coverage changes the patient amount. Explain potential cost before enrollment.
Payment boundaryDo not bill RPM and RTM concurrently for the same patient under Medicare. Do not count the same management time under another service. Part D MTM and pharmacy dispensing are different programs, not shortcuts to RTM billing.
2026 code reference and an illustrative service check
A qualifying musculoskeletal device with 18 data days may fit the longer device-supply pathway. Eligible management and live communication are checked separately. Initial setup is not billed every month. Add-on 98981 requires 98980; it is not an add-on to 98979.
These are code-family summaries, not complete descriptors or payment estimates. Check the current code set, payer, clinician, setting, date, unit edits, and required add-on base code.
| Code / pathway | What it describes | Before billing |
|---|---|---|
| 98975 | Initial setup and patient education | Confirm the qualifying technology, actual setup and education. |
| 98984 / 98976 | Respiratory device supply, 2–15 / 16–30 days | Match respiratory domain and actual qualifying data days in a 30-day period. |
| 98985 / 98977 | Musculoskeletal device supply, 2–15 / 16–30 days | Match musculoskeletal domain, device, and actual data days. |
| 98986 / 98978 | Cognitive-behavioral-therapy device supply, 2–15 / 16–30 days | Verify qualifying CBT device, coding and payer coverage; ordinary screening does not suffice. |
| 98979 | First 10 minutes of treatment management | Check qualified professional time and real-time interactive communication. |
| 98980 / 98981 | First and additional 20 minutes of treatment management | Confirm eligible time, communication, supervision, and no duplicated minutes. |
Questions before a claim
Can a pharmacist participate?
Potentially as appropriate staff or contracted support within an eligible billing practice, subject to code, supervision, payer, and state-scope review. That is different from independently billing Part B RTM.
Can an independent pharmacy bill RTM?
Do not assume so. A pharmacy may explore a contracted role with a treating practice or a separate sponsor-defined medication program; the actual billing pathway must be verified.
Is a physical device required?
Not necessarily dedicated hardware, but the chosen software or device must qualify for the specific RTM service. A generic app or phone calls alone do not establish device-supply billing.
FINANCIAL PICTURE
See how participation, collections, and costs change the result.
Start with one supported pathway. Do not multiply every patient by every possible code. Use verified payer terms and the written PrimeVital scope before making a business decision.
Illustrative RTM model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. PrimeVital pilot terms are not modelled automatically. Replace them with your verified contract, service mix, and cost assumptions.
Estimate net after your agreed service fee and other costs
Enter the total fees from your written agreement. No fee is prefilled. Pilot service fees are paid from collections; treatment of denied or insufficient collections must be agreed before launch.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Illustrative collections before service and practice costs: $3,500. This uses the hypothetical per-patient amount and collection rate above; it is not a code-specific Medicare estimate.
To estimate the amount remaining for the practice, open the cost section and enter the total service fee from a written proposal. We do not invent a PrimeVital price or show a misleading net amount before that is known.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO MEASURE
Define success before the first patient starts.
Agree on a baseline and review period. These are measures to track, not promised results or guaranteed payment.
Participation
Useful treatment reports and obstacles to using the tool.
Function
A relevant measure chosen by the treating therapist.
Treatment response
Plan changes and patient understanding of next steps.
PRIMARY SOURCES
Check the rule before a real claim.
Reviewed October 7, 2026 against current CMS guidance. These guides describe 2026 pathways; proposals for later years are not effective requirements. Coverage, contracts, scope, and patient facts can change the answer.
APPLY THIS TO YOUR PRACTICE
Start with a patient group and a clear question.
Tell us your practice type, payer mix, and workflow. We can map clinical fit, your involvement, available support, launch requirements, and financial assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com