RTM vs RPM: Which One Applies to Your Practice?

Remote Therapeutic Monitoring (RTM) and Remote Patient Monitoring (RPM) are both valuable reimbursement pathways for practices that monitor patients between visits — but they apply to fundamentally different clinical situations, cover different types of data, and use completely different CPT code sets. Confusing the two is one of the most common mistakes practices make when exploring remote monitoring billing, and the confusion tends to resolve in one of two unhelpful directions: either the practice bills incorrectly and faces denials, or it concludes it doesn’t qualify for anything and leaves significant revenue uncaptured. Understanding the actual distinction is the starting point for billing either program correctly.

The Key Difference

The foundational difference between RTM and RPM is the type of data being monitored. RPM monitors physiologic data — objective, device-measured health metrics like blood pressure, heart rate, blood glucose, oxygen saturation, and weight. RTM monitors therapeutic data — information about how patients are responding to and adhering to their treatment plan, including musculoskeletal function, pain levels, therapy adherence, medication adherence, and behavioral health metrics.

This distinction has significant clinical implications. RPM is designed for patients with chronic conditions where physiologic measurement is the central monitoring need — hypertension, diabetes, heart failure, COPD. RTM is designed for patients undergoing active therapeutic treatment where adherence and functional response are the central monitoring needs — post-surgical rehabilitation, chronic pain management, physical therapy, occupational therapy, behavioral health treatment.

A patient recovering from knee replacement surgery does not need their blood pressure monitored remotely — their surgeon needs to know whether they are doing their home exercises, how their pain is responding to activity, and whether their functional range of motion is improving on trajectory. That is an RTM use case. A patient with hypertension does not need their therapy adherence monitored — their cardiologist needs to see their daily blood pressure readings. That is an RPM use case.

What RTM Covers

Remote Therapeutic Monitoring (RTM) was established as a distinct billing category in 2022 and covers the monitoring of non-physiologic therapeutic data. The covered data categories include musculoskeletal system status, respiratory system status, therapy adherence, and therapy response. In practice, this translates to monitoring programs built around home exercise compliance, pain level tracking, functional outcome measures, medication adherence for therapeutic regimens, and behavioral health metric tracking.

RTM is billed using CPT codes 98975 through 98981. Code 98975 covers initial setup and patient education on the use of the RTM equipment. Code 98976 covers the device supply for respiratory system monitoring. Code 98977 covers the device supply for musculoskeletal system monitoring. Codes 98980 and 98981 cover the clinical staff and practitioner time spent reviewing data and interacting with the patient — 98980 for the first 20 minutes of monthly interaction, and 98981 for each additional 20-minute increment.

A key point about RTM is that clinical staff — not just physicians — can perform the monitoring and interaction under RTM. Physical therapists, occupational therapists, speech-language pathologists, and other qualified healthcare professionals can bill RTM under their own NPI, which is not the case for all RPM codes.

What RPM Covers

Remote Patient Monitoring (RPM) has been available since 2019 and covers the collection, transmission, and clinical management of physiologic data. The code set runs from 99453 through 99458. Code 99453 covers setup and patient education. Code 99454 covers the supply of the monitoring device. Codes 99457 and 99458 cover practitioner time spent reviewing data and communicating with the patient — 99457 for the first 20 minutes monthly, and 99458 for each additional 20-minute increment.

RPM applies to patients with diagnosed chronic conditions where ongoing physiologic measurement adds clinical value. The most common RPM applications are hypertension (blood pressure monitoring), diabetes (glucose monitoring), heart failure (weight and fluid status), and COPD (oxygen saturation). Primary care practices, cardiologists, endocrinologists, and pulmonologists are the primary RPM billing specialties.

CPT Code Comparison

For practices evaluating which program applies, the code comparison breaks down as follows. RTM setup is billed under 98975; RPM setup under 99453. RTM device supply uses 98976 or 98977 depending on the system monitored; RPM device supply uses 99454. RTM practitioner time uses 98980 and 98981; RPM practitioner time uses 99457 and 99458. The reimbursement rates are broadly comparable across the two code sets, though specific rates vary by payer, year, and geographic region.

The critical distinction in payer coverage is that Medicare covers both RTM and RPM, but commercial payer coverage varies significantly. Many commercial payers that cover RPM have been slower to cover RTM, though coverage has expanded substantially since 2023. Before implementing either program, verifying payer-specific coverage for your patient population is essential.

Which Specialties Qualify for Which

Physical therapy, occupational therapy, and speech-language pathology practices almost exclusively qualify for RTM. They do not generate the physiologic monitoring data required for RPM, but they are perfectly positioned for RTM’s therapeutic monitoring framework. Pain management practices similarly qualify primarily for RTM when monitoring functional outcomes and medication adherence for musculoskeletal conditions. Behavioral health practices qualify for RTM under the behavioral health monitoring codes.

Primary care, cardiology, endocrinology, and pulmonology practices are the natural home of RPM. These specialties manage the chronic conditions — hypertension, diabetes, heart failure, COPD — where physiologic remote monitoring adds clear clinical value and has the strongest reimbursement support.

Some specialties can legitimately bill both. A family medicine practice might bill RPM for a hypertensive patient and RTM for a patient recovering from a musculoskeletal injury. An internal medicine practice managing a patient with both diabetes and chronic low back pain might use both monitoring programs for different aspects of that patient’s care.

Common Misconceptions

The most common misconception is that RPM is the “real” remote monitoring program and RTM is newer and less supported. In practice, RTM has strong Medicare coverage and growing commercial coverage, and it applies to a broader range of outpatient practices than RPM does. The practices that dismiss RTM because they’ve heard more about RPM are often leaving more revenue on the table than the practices that dismiss RPM because they assume remote monitoring doesn’t apply to them.

A second misconception is that remote monitoring requires expensive, clinic-supplied devices. While device supply is part of the billing equation for both RTM and RPM, many RTM applications use patient smartphones and simple app-based monitoring rather than dedicated medical devices — which lowers the program startup cost significantly and improves patient participation rates.

If you are a physical therapist, occupational therapist, pain management specialist, or behavioral health provider, RTM is almost certainly the right program for your practice. If you are a primary care physician managing chronic disease, RPM is likely the better fit. And if you are still unsure, the answer is usually in the data: what are you monitoring, and why? Physiologic data points to RPM. Therapeutic data points to RTM.

Can a Practice Bill Both RTM and RPM?

Yes, with important caveats. A practice can legitimately bill both RTM and RPM for the same patient if the two monitoring programs address distinct clinical needs with distinct monitoring data. A patient with hypertension and a chronic musculoskeletal condition might have their blood pressure monitored under RPM (99454) while their physical therapy adherence and pain response are monitored under RTM (98977). The two programs are clinically and documentationally separate.

What practices cannot do is bill RPM and RTM for overlapping clinical services for the same patient in the same period. If a practice is providing general health monitoring that could be characterized as either physiologic or therapeutic and bills both code sets for the same monitoring activity, that is a billing error with audit risk. The programs must address different clinical conditions or different monitoring objectives with separately documented consent, monitoring plans, and review records.

In practice, dual RTM/RPM billing is most common in primary care and internal medicine practices with broad patient panels. These practices may have patients who are both managing chronic conditions requiring physiologic monitoring (hypertension, diabetes) and recovering from or managing conditions requiring therapeutic monitoring (post-surgical rehabilitation, chronic musculoskeletal pain). For each patient, the appropriate program depends on what is actually being monitored and why.

Reimbursement Comparison

RTM and RPM reimbursement rates are broadly comparable under Medicare, with some variation by code. For 2026, the comparable code pairs are:

• Setup: RTM 98975 (~$19) vs. RPM 99453 (~$18 to $20)
• Device supply: RTM 98977 (~$48 to $55/month) vs. RPM 99454 (~$55 to $65/month)
• Treatment management, first 20 min: RTM 98980 (~$48 to $62/month) vs. RPM 99457 (~$50 to $65/month)
• Treatment management, additional 20 min: RTM 98981 (~$38 to $45) vs. RPM 99458 (~$38 to $45)

The monthly combined revenue per patient is comparable between the two programs at roughly $100 to $130 per patient per month for the baseline two-code combination. The difference in commercial payer coverage — where RPM coverage is more consistently established than RTM coverage for some payer-specialty combinations — can produce different effective blended rates depending on a practice’s payer mix. Practices that have a high proportion of commercial patients should verify RTM coverage with each commercial payer before comparing the revenue opportunity.

The Supervision Requirement Difference

One practically significant difference between RTM and RPM is the supervision model for clinical staff time. For RPM (99457, 99458), the service must be provided by the billing practitioner or by clinical staff under direct or general physician supervision, and the physician must personally interact with the patient during the billing month. For RTM (98980, 98981), there is no requirement that the billing practitioner personally interact with the patient in every billing month — clinical staff can perform monitoring and management services under general supervision without requiring a monthly physician-patient interaction.

This distinction matters significantly for high-volume RTM programs where the monitoring work is largely performed by clinical staff. Under RTM, a medical assistant or care coordinator can review monitoring data, document the review, interact with the patient as needed, and that time counts toward the 98980 threshold under general physician supervision — without requiring the physician to be present for each interaction. This is more operationally flexible than the RPM supervision model and is one reason that RTM is better suited to large panel monitoring programs in therapy and pain management settings.