CMS 2026 rules make RPM and RTM more accessible than ever. Here's what the billing actually looks like — by CPT code, by payer, and by practice size.
Get Your Custom Revenue Model| CPT Code | Description | Medicare Ref | Commercial (130–160%) | Workers' Comp (150–200%) | Key Threshold |
|---|---|---|---|---|---|
| 98975 | RTM Setup & Education One-time per patient enrollment | ~$21 | $27–$34 | $32–$42 | Once |
| 98976 | RTM Device Supply — Respiratory Resp. therapy data, 16+ days/month | ~$58 | $75–$93 | $87–$116 | 16 data days |
| 98977 | RTM Device Supply — MSK Musculoskeletal data, 16+ days/month | ~$47 | $61–$75 | $71–$94 | 16 data days |
| 98978 | RTM Device Supply — Behavioral Cognitive/behavioral data, 16+ days | ~$47 | $61–$75 | $71–$94 | 16 data days |
| 98980 | RTM Treatment Management — First 20 min Clinical staff time, 10 min threshold (2026) | ~$59 | $77–$94 | $89–$118 | 10 min/month |
| 98981 | RTM Treatment Management — Each add'l 20 min Billable once per additional 20-min block | ~$41 | $53–$65 | $62–$82 | +20 min |
| 98982 | RTM Device Supply — Cognitive Cognitive function monitoring, 2+ days (2026) | ~$47 | $61–$75 | $71–$94 | 2 data days |
| 98984 | RTM Device Supply — General Therapeutic Broad patient-reported therapeutic data | ~$47 | $61–$75 | $71–$94 | 2 data days |
| 98985 | RTM Device Supply — MSK 2-15 Days Lower-threshold MSK supply code | ~$47 | $61–$75 | $71–$94 | 2 data days |
*Medicare reference rates only. DCs cannot bill RTM to Medicare. Commercial and Workers' Comp rates reflect typical 130–200% multipliers. Actual rates vary by state and payer contract.
| CPT Code | Description | Medicare | Commercial (130–160%) | Workers' Comp (150–200%) | Key Threshold |
|---|---|---|---|---|---|
| 99453 | RPM Setup & Education One-time device setup and training | ~$21 | $27–$34 | $32–$42 | Once |
| 99454 | RPM Device Supply — 16+ Days Device supply and daily transmission monitoring | ~$55 | $72–$88 | $83–$110 | 16 data days |
| 99457 | RPM Management — First 20 min Physician/clinical staff time, interactive communication | ~$51 | $66–$82 | $77–$102 | 20 min/month |
| 99458 | RPM Management — Each add'l 20 min Billable per additional 20-min block | ~$41 | $53–$65 | $62–$82 | +20 min |
| 99091 | RPM Data Collection/Interpretation Physician 30-min review of collected data | ~$58 | $75–$93 | $87–$116 | 30 min/month |
Select your specialty and patient volume. This is a conservative estimate — actual revenue depends on payer mix, code selection, and qualification rates.
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