If you're in healthcare leadership, you've likely heard both "RTM" and "RPM" mentioned in the same breath. While they sound similar and both involve remote monitoring, they serve fundamentally different purposes. Understanding this distinction is critical for implementing the right solution for your patient population, and for maximizing reimbursement.

What's New for 2026: CMS has significantly expanded RTM billing opportunities, making it easier and more profitable to monitor therapeutic compliance. This guide reflects all 2026 changes.

The Core Difference

Remote Patient Monitoring (RPM) tracks physiological data:

• Blood pressure readings

• Heart rate and oxygen saturation

• Weight measurements

• Blood glucose levels

• Temperature

Remote Therapeutic Monitoring (RTM) tracks therapeutic compliance and response:

• Medication adherence (doses taken vs. missed)

• Self-reported symptoms

• Therapy compliance (physical therapy exercises, respiratory therapy)

• Treatment response data

• Pain scales and functional assessments

The key insight: RPM tells you what's happening in a patient's body. RTM tells you what the patient is doing about it.

A Real-World Scenario

Consider Mrs. Johnson, a 72-year-old with congestive heart failure, diabetes, and hypertension. She takes 11 medications daily.

With RPM only:

• You see her blood pressure is 165/95 (elevated)

• Her weight increased 4 pounds this week

• Her blood glucose is trending upward

What you don't know:

• Did she take her blood pressure medication today?

• Has she been skipping her diuretic?

• Is she taking her diabetes medications as prescribed?

With RTM added:

• You discover she's been missing her evening medications 40% of the time

• She skipped her diuretic 3 times this week

• Her morning diabetes medication adherence is 95% but evening is only 60%

Now you can intervene effectively: The problem isn't that her conditions are worsening, it is that she's not taking her medications consistently. A quick nursing call reveals she forgets her evening doses when her routine changes. You adjust her reminder schedule, and within two weeks, her adherence improves to 92% and her vitals stabilize.

CPT Codes & Reimbursement (2026 Rates)

RPM Codes:

• CPT 99453: Initial setup and patient education (~$20)

• CPT 99454: Device supply with daily recording (~$64/month)

• CPT 99457: First 20 minutes of clinical staff time (~$52)

• CPT 99458: Each additional 20 minutes (~$42)

Requirements:

• 16 days of data transmission per month

• At least 20 minutes of interactive communication

RTM Codes (Updated for 2026):

The codes would cover: Medication adherence monitoring (like LynxFlow does), Physical therapy exercise compliance, Rehabilitation tracking, Pain management therapy, Self-management programs, Treatment response monitoring

Setup & Education:

• CPT 98975: Initial setup and patient education ($21.71)

  • One-time fee per episode of care

  • Can be performed by clinical staff

Device Supply - NEW LOWER THRESHOLD:

• CPT 98985: device supply, 2-15 days ($40.08/month) (NEW for 2026)

  • Previously, patients needed 16 days to bill anything

  • Now you can bill for short-term or episodic monitoring

  • Perfect for post-discharge, trial periods, mid-month enrollments

  • CPT 98977: device supply, 16-30 days ($40.08/month)

    • Clarified from "16+ days" to specific range

    • Standard billing for ongoing monitoring programs

Treatment Management - NEW LOWER TIME THRESHOLD:

• CPT 98979: 10-19 minutes of clinical time ($26.39) (NEW for 2026)

  • Game changer: Previously minimum was 20 minutes

  • Now 15 minutes of clinical time is billable

  • Must include one real-time interactive communication

• CPT 98980: 20-39 minutes of clinical time ($54.11)

  • Clarified from "20+ minutes" to specific range

  • Must include one real-time interactive communication

• CPT 98981: Each additional 20 minutes ($41.42)

  • Bill after 98980 for high-intensity patients

Requirements (Updated):

• Minimum 2 days of data transmission for 98985 (was 16 days)

• Minimum 10 minutes of clinical time for 98979 (was 20 minutes)

• At least one real-time interactive communication required (phone, video, in-person)

Critical difference: RTM doesn't require physiological monitoring devices. Medication adherence monitoring, symptom tracking via app, and therapy compliance all qualify.

Why the 2026 Changes Matter

More Patients Qualify:

Before 2026: If patient transmits data for 12 days, it would equate to $0 revenue

With 2026: If patient transmits data for 12 days, it would generate $66.47 revenue (98985 + 98979)

More Clinical Time is Billable:

Before 2026: If a nurse spends 15 minutes on RTM, it would equate to $0 revenue

With 2026: If a nurse spends 15 minutes on RTM, it would generate $26.39 revenue (98979)

Expanded Use Cases:

• Post-discharge monitoring (2-3 weeks)

• Trial/pilot programs (testing patient engagement)

• Mid-month enrollments (partial month billing)

• Brief clinical interventions (10-15 minute touchpoints)

When to Use Each

Use RPM when:

• Patient has unstable vital signs requiring frequent monitoring

• Recent hospital discharge with high readmission risk

• Chronic conditions requiring physiological data (CHF, COPD, diabetes)

• Provider needs to track disease progression

• Documentation needed for value-based care metrics

• Clinica Trials

• At risk patient population (elderly, patients with dementia, or patients with psychiatric conditions) undergoing chemotherapy for cancer to monitor for toxicity

Use RTM when:

• Medication adherence is a concern

• Patient is on complex medication regimens (5+ medications)

• Therapy compliance needs tracking (PT, respiratory therapy)

• Self-management behaviors need monitoring

• Treatment response assessment is needed

• Short-term monitoring needs (post-discharge, acute episodes, oral chemotherapy)

Use BOTH when:

• High-risk patients with multiple chronic conditions

• Post-discharge transitional care

• Patients with both physiological instability AND adherence concerns

• Maximizing preventive intervention opportunities

The Business Case for Combining RPM + RTM (Taking into consideration 2026 Rates)

Let's look at the numbers for a 100-patient program:

RPM Alone (average reimbursement):

• Setup: $2,000 (100 patients × $20)

• Monthly device: $6,400/month ($64 × 100)

• Clinical time: $5,200/month (avg $52 per patient)

• Annual: $140,200

RTM Alone (2026 rates):

• Setup: $2,171 (100 patients × $21.71)

• Monthly device (mix of 98985/98977): $4,008/month ($40.08 × 100)

• Clinical time (mix of 98979/98980): $4,025/month (avg $40.25 per patient)

• Annual: $98,567

RPM + RTM Combined:

• Can bill both for same patient (different modalities)

• Setup: $4,171

• Monthly device: $10,408

• Clinical time: $9,225

• Annual: $238,767

Plus documented cost savings:

• Prevented readmissions: ~$200,000

• Reduced ER visits: ~$50,000

• Net benefit Year 1: ~$488,767

Per patient annual benefit: ~$4,888

2026 Billing Optimization Strategies

Strategy 1: Leverage New Short-Term Codes

Opportunity: 98985 opens up new revenue from previously unbillable patients

Example:

• Post-discharge patient monitored for 2 weeks (10 days of data)

• 12 minutes of nursing time

• Revenue: $66.47 (was $0 before 2026)

• Extrapolate: 20 such patients/month = $15,948 annual

Strategy 2: Capture 10-19 Minute Interventions

Opportunity: 98979 captures clinical time that was previously lost

Example:

• Review adherence data: 5 minutes

• Brief phone check-in: 8 minutes

• Total: 13 minutes - Now billable at $26.39

• Before 2026: $0 (didn't hit 20-minute threshold)

Strategy 3: Risk Stratification for Maximum Efficiency

High-Risk Tier (30% of patients):

• 40-60 minutes monthly clinical time

• Bill: 98977 + 98980 + 98981

• Revenue: $135.61/month per patient

Medium-Risk Tier (50% of patients):

• 20-30 minutes monthly clinical time

• Bill: 98977 + 98980

• Revenue: $94.19/month per patient

Low-Risk/Short-Term Tier (20% of patients):

• 10-15 minutes monthly clinical time

• Bill: 98985 + 98979

• Revenue: $66.47/month per patient

Weighted Average Revenue per Patient: $106.76/month

Implementation Considerations

Technology Requirements

For RPM:

• Connected devices (blood pressure cuffs, scales, glucometers)

• Cellular connectivity or Bluetooth bridges

• Device management platform

• Integration with patient data systems that can provide analytics such as Lynxflow Health

For RTM:

• Smart pill dispensers or medication tracking devices (supplied through Lynxflow health)

• Mobile apps for symptom reporting

• Two-way communication system

• Adherence analytics platform

LynxFlow Health advantage: Our platform combines both, eliminating the need for multiple vendors and providing unified patient view with built-in 2026 compliance tracking.

Workflow Integration

RPM workflow:

1. Review physiological data dashboard

2. Identify out-of-range readings

3. Contact patients with abnormal values

4. Adjust treatment plans based on data

RTM workflow (optimized for 2026):

1. Review adherence reports and alerts

2. Identify patients with declining adherence

3. Proactive outreach before clinical deterioration

4. Document time to capture 10-19 minute interventions (NEW)

5. Investigate barriers to adherence

Combined workflow:

1. Single dashboard shows both vital signs and adherence

2. Correlate poor adherence with deteriorating vitals

3. Earlier intervention window

4. More targeted clinical conversations

5. Efficient time tracking for both RPM and RTM billing

Staffing Models

RPM requires:

• Clinical staff (RN, LPN) to interpret vital signs

• Protocol-driven response to abnormal values

• Provider oversight and care plan adjustments

RTM requires:

• Can be managed by care coordinators or nurses

• Less intensive clinical interpretation

• Focus on behavioral coaching and barrier identification

• With 2026 changes: Even brief interventions are now billable

Combined approach:

• Same staff can manage both

• More complete patient picture

• Better use of nursing time

• 2026 bonus: Lower time thresholds mean more billable encounters

Common Mistakes to Avoid (Updated for 2026)

Mistake #1: Not leveraging new short-term codes

Problem: Continuing to require 16 days before enrolling patients

Solution: Use 98985 for short-term monitoring (2-15 days) Impact: Missing 15-20% additional revenue opportunity

Mistake #2: Not documenting 10-19 minute interventions

Problem: Only billing when hitting 20 minutes

Solution: Use 98979 for brief but valuable clinical touchpoints Impact: Leaving $26.39 on the table per interaction

Mistake #3: Billing both 98985 (device supply 2-15 days) and 98977 (device supply 16+ days) in same period

Problem: Violates CPT guidelines

Solution: Choose one based on total days transmitted Impact: Claim denials and audit risk

Mistake #4: Ignoring adherence data

Having RPM data showing worsening vitals while ignoring that the patient is not taking medications is treating symptoms instead of root causes.

Mistake #5: Separate platforms

Using different vendors for RPM and RTM creates fragmented data, duplicate workflows, and frustrated staff.

Mistake #6: Not billing for both

If you're doing both RPM and RTM activities, you should bill for both. They're separate CPT codes for a reason.

Mistake #7: Poor patient selection

Not every patient needs both. Use risk stratification to identify who benefits most from combined monitoring.

Mistake #8: Not having a knowledgeable partner for workflow implementation, quality assurance, EHR integration, and Analytics

Solution: Partner with Lynxlow Health

Patient Selection Framework (2026 Updated)

RPM only candidates:

• Physiologically unstable

• Good medication adherence

• Recent device implant requiring monitoring

• Conditions primarily managed by vital sign tracking

RTM only candidates:

• Stable vitals

• Complex medication regimens

• History of non-adherence

• Conditions primarily managed by medication

• NEW: Short-term post-discharge monitoring (2-3 weeks)

• NEW: Trial candidates for long-term monitoring

RPM + RTM candidates:

• Multiple chronic conditions

• High readmission risk

• Both physiological instability and adherence concerns

• Post-discharge within 30 days

• High-cost, high-utilization patients

2026 Documentation Requirements:

For 98985 (2-15 days):

·       Document exact days of transmission (not just ">2")

·       Must have documented monitoring plan

·       Cannot bill both 98985 and 98977 in same 30-day period

For 98979 (10-19 minutes):

·       Time documented to the minute (e.g., "12 minutes" not "10-15 minutes")

·       Must include at least one real-time interactive communication

·       Document what was discussed and clinical decisions made

·       Cannot bill if total time <10 minutes

For Combined RPM + RTM:

·       Separate documentation for each modality

·       Time cannot be double-counted

·       Different staff members can perform RPM vs RTM activities Both can be billed in same calendar month

The Future: Integrated Monitoring

The future of remote care isn't RPM vs. RTM, it is comprehensive remote care management that includes:

• Physiological monitoring (RPM)

• Therapeutic monitoring (RTM)

• Social determinants of health screening

• Predictive analytics

• Automated intervention protocols

With the 2026 changes lowering barriers to RTM billing, integrated platforms that track both physiological data and therapeutic adherence are now more valuable than ever.

Conclusion

RPM and RTM aren't competing technologies, they are complementary tools that address different aspects of patient care. RPM tells you what is happening physiologically. RTM tells you what the patient is doing therapeutically. Together, they provide the complete picture needed for effective remote care management.

The 2026 changes make this combination more accessible and profitable than ever:

• Lower thresholds mean more patients qualify

• Shorter interactions are now billable

• Greater flexibility in program design

• Significant revenue expansion opportunity

The organizations seeing the best outcomes and highest ROI are those implementing both strategically, using unified platforms that provide clinicians with comprehensive patient data in a single workflow while maximizing the new 2026 billing opportunities.

Ready to implement comprehensive remote monitoring with 2026 optimization or have Questions about RTM vs RPM under the new 2026 rules? Email us at info@lynxflowhealth.com

Disclaimer: This guide reflects the CMS CY 2026 Medicare Physician Fee Schedule Final Rule (October 31, 2025). Billing regulations may vary by payer and region. Reimbursement rates are national averages. Consult with qualified billing professionals for specific situations.

Last Updated: December 31, 2025