Beyond Medicare: Understanding Commercial Reimbursement for Remote Therapeutic Monitoring (RTM)

For outpatient rehab providers, remote therapeutic monitoring (RTM) is becoming an increasingly important component of effective digital and hybrid care. RTM allows PTs, OTs, and other qualified healthcare professionals to remotely monitor patient-reported data related to functional progress, adherence, and symptoms between in-person visits—and in many cases, get reimbursed for it. While Medicare reimbursement for RTM is relatively well understood, commercial reimbursement remains more variable and often less transparent.

Some commercial payers are beginning to follow Medicare’s lead by recognizing RTM CPT codes. However, coverage policies, documentation requirements, and payment rates can vary significantly by payer and by plan. As a result, clinics may overlook reimbursement opportunities or struggle to confidently validate coverage.

The purpose of this article is to help clinicians and administrators better understand how to evaluate commercial RTM reimbursement opportunities, identify reliable national and state-level resources, and strengthen documentation practices. The information shared is drawn from publicly available sources and is intended for educational purposes only, not as legal, billing, or coding advice. 

How to Determine Which Commercial Payers Reimburse for RTM

Start With Your Own Payer Contracts

A good place to begin is within your own payer agreements and policies. Because commercial coverage for RTM isn’t standardized, ensure that your team is routinely reviewing your highest-volume commercial payers for RTM-specific language.

Consider the following steps:

• Review medical policies for references to RTM, digital health services, or remote monitoring CPT codes.

• Search payer websites for RTM coverage bulletins or policy updates related to digital health or remote monitoring.

• Contact your provider relations representative to ask whether RTM CPT codes are recognized and reimbursed under your contract.

• Check with your state APTA chapter, which may be aware of regional payer trends or common coverage patterns.

Keep in mind that it’s important to regularly validate any existing coverage, as payer policies can change with limited notice.

Use Claims Experience to Help Clarify Coverage

Even with careful research, it’s possible to come up empty-handed. Many commercial payers don’t publish clear RTM guidance, and provider relations teams might not be able to give definitive answers. In that case, an alternative approach is to simply submit RTM claims that follow AMA guidance to all of your payers in order to understand which plans reimburse for RTM and which don't. It’s not the most elegant approach, but in practice, it’s sometimes the only way to get clarity when formal guidance is limited.

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National Coverage Indicators

Although commercial reimbursement varies, several national resources can help clinics understand how RTM is being positioned.

AMA: Commercial Coverage for Digital Health Codes

The American Medical Association (AMA) maintains resources related to CPT codes and digital health services, including RTM. These materials outline which CPT codes exist, how they are categorized, and, in some cases, how commercial plans are adopting them.

Organizations can use this information as a starting point for identifying whether commercial payers are recognizing RTM codes, even if payment rates and policies differ.

APTA State Medicaid Payment Rate Guide

The American Physical Therapy Association (APTA) publishes a State Medicaid Payment Rate Guide that includes RTM rates for many states. Although this guide focuses on Medicaid rather than commercial plans, it provides important insight into how RTM is being adopted at the state level. In addition, commercial payers sometimes align with Medicaid or Medicare precedents within a given state.

The guide indicates that the following states may be reimbursing for 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.

State-Based Insurance Commission Publications

Some state insurance departments and commissions publish guidance or bulletins related to digital health services and telehealth coverage, which might provide additional context.

Tips to Improve Your Documentation for RTM

Strong documentation is essential for optimizing reimbursement, regardless of payer. Clear records help demonstrate medical necessity, patient engagement, and compliance with CPT code requirements.

Documentation Recommendations from APTA 

Plan of care: Therapy clinicians can only bill RTM codes if they are part of a therapy plan of care. Clinicians should document progress toward established goals and what they hope to achieve using RTM. The RTM episode begins when the clinician turns it on and ends when the established goals in the patient’s care plan are met.

Patient consent: Document that the patient has agreed to receive RTM services.

98975: Document the type of device or platform being used and any education or training provided to the patient to set up the device.

98985: Document the RTM platform name, description, and number of days that data was transmitted. The AMA clarifies that the data may be related to signs, symptoms, compliance, and functions of a therapeutic response. Note: The APTA states that data indicating a lack of engagement may also qualify as a day of data transmission, but must be followed up on in a timely manner.

98977: Document the RTM platform name, description, and number of days that data was transmitted. The AMA clarifies that the data may be related to “signs, symptoms, compliance, and functions of a therapeutic response.”

98979: Document the data gathered from the device, the date and time of the patient interaction, and any decisions made that impact the treatment and plan of care as a result of the monitoring.

98980: Document the data gathered from the device, the date and time of the patient interaction, and any decisions made that impact the treatment and plan of care as a result of the monitoring.

98981: Document the data gathered from the device, the date and time of the additional patient interaction(s), and any decisions made that impact the treatment and plan of care as a result of the monitoring. Note: CMS clarified that 98979, 98980, and 98981 “require a live, interactive communication with the patient/caregiver. The interactive communication contributes to the total time, but it does not need to represent the entire cumulative reported time of the treatment management service.”

Additional Practical Tips and Suggested Workflows

In addition to formal documentation requirements, many organizations find success by establishing consistent internal workflows and standardized processes to support RTM. For example:

• Assign dedicated time each week for RTM data review and patient outreach, including calling or messaging patients within the first few days to reinforce engagement.

• Align RTM check-ins with in-clinic visits to support continuity of care and reinforce treatment goals.

• Clearly define team roles across RTM enablement, including in-person therapy, data review and monitoring, patient communication, and documentation.

• Use standardized documentation templates for RTM interactions and clinical decision-making.

Organizations may also benefit from creating clear, repeatable processes for:

• RTM enablement and in-clinic patient enrollment

• Monitoring on a regular cadence, and interactive communications with patients as needed to support their progress

• Showing providers when to bill codes and how documentation should be structured for your payers 

Don’t Leave RTM on the Table in 2026

RTM codes in 2026 mark a new turning point. With lower thresholds and easier reimbursements, organizations have a real opportunity to create new revenue streams at a time when margins are under pressure. The question is no longer whether RTM is worth considering, but whether you can afford to leave it on the table. We can help you get started with our integrated, easy-to-use solution. Learn more or request a demo today.

Disclaimer

All information in this article is accurate as of the publication date. This article is intended for educational purposes only and does not constitute legal, billing, coding, or compliance advice. Coverage policies, payment rates, and payer decisions regarding RTM are subject to change. Commercial and Medicaid policies should always be verified directly with each payer prior to billing. All billing decisions remain the responsibility of the billing clinician and clinic.