Surgical · General

Initial setup and patient education for a remote therapeutic monitoring (RTM) device or software platform — billed once per episode of care.

Verified May 8, 2026 · 8 sources ↓

Medicare: $21.71
Total RVUs: 0.65
Global, days
Region: General

Drawn from CMSLimberhealthGetorvaCarepathsEmbodihealth

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Written patient consent for remote therapeutic monitoring, documented in the chart
Identity of the specific RTM device or software platform used (name, model, or app version)
Date and content of the education session — include instructions given on data entry frequency, transmission, and device operation
Confirmation that the patient or caregiver demonstrated understanding and was successfully onboarded
At least two days of transmitted RTM data within a 30-day period before submitting the claim (2026 threshold for 98975)
Therapy plan of care on file when billed by a PT, OT, or SLP — RTM services furnished by therapists must always be under a plan of care
Applicable therapy discipline modifier (GP, GO, or GN) and CQ or CO if a PTA or OTA performed any part of the setup

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 52 Reduced services 59 Distinct service KX Documentation on file

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

98975 covers the one-time setup session at the start of an RTM episode: providing the patient with the device or FDA-cleared app, pairing it to their profile, and educating them on how to log data, charge or activate the device, and transmit readings. Bill it once that foundational work is complete — it cannot be rebilled for the same RTM episode. If a patient later restarts monitoring under a new episode of care with a new device or program, a second 98975 is appropriate.

For 2026, the minimum data threshold to bill 98975 is at least two days of transmitted RTM data within a 30-day period. (Prior guidance cited 16 days; that 16-day standard applies to the monthly device supply codes 98976 and 98977, not to the setup code.) Therapists billing 98975 must append the appropriate therapy discipline modifier — GP for PT, GO for OT, GN for SLP. If a PTA or OTA performs any portion of the setup or education, apply CQ or CO as required by the de minimis (10%) rule under CMS policy. When the setup session occurs on the same day as a separately billable E/M or therapy evaluation, append modifier 25 to the E/M to distinguish it from the RTM service.

Eligible billing providers include physicians, NPs, PAs, physical therapists, occupational therapists, and speech-language pathologists. Under the 2024 CMS Final Rule, PTAs and OTAs may furnish RTM services under general supervision of their respective PT or OT. Therapists must always link 98975 to a therapy plan of care. Place of service is typically 11 (office). No co-pay applies — this is not a clinic visit.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0
Practice expense RVU	0.63
Malpractice RVU	0.02
Total RVU	0.65
Medicare national rate	$21.71
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$21.71
HOPD (APC 5012) Hospital outpatient department	$136.02

Common denial reasons

The recurring reasons claims for CPT 98975 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or unsigned therapy plan of care when billed by a PT, OT, or SLP
Billing 98975 more than once for the same episode of care without documentation of a new RTM episode or new device
Absence of patient consent documentation for remote monitoring
Claim submitted before minimum RTM data days are confirmed and documented
Therapy discipline modifier (GP, GO, GN) omitted when billed by a therapist
Same-day E/M billed without modifier 25, triggering a bundling edit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01How many times can I bill 98975 per patient?

Once per episode of care. If the patient stops RTM and later restarts under a new monitoring plan with a new device or program, that constitutes a new episode and supports a second 98975.

02What is the 2026 data threshold for billing 98975?

At least two days of transmitted RTM data within a 30-day period. The 16-day requirement applies to the monthly device supply codes 98976 and 98977 — not to the setup code 98975.

03Can I bill 98975 and an E/M on the same day?

Yes. Append modifier 25 to the E/M code to show it is a significant, separately identifiable service distinct from the RTM setup and education.

04Do PTAs and OTAs need a modifier when performing the 98975 setup?

Yes. If a PTA performs any portion of the setup or education, append CQ. For OTAs, use CO. The supervising PT or OT must provide general supervision. The 15% payment reduction tied to those modifiers applies to 98975 under CMS policy.

05Is modifier KX required for 98975?

Only if the patient is at or near the Medicare outpatient therapy cap threshold and the service is medically necessary. In that scenario, KX attests that documentation supporting medical necessity is on file.

06Can 98975 be billed on the same day as 98977 or 98980?

Yes. 98975 is the setup code; 98977 covers the monthly musculoskeletal device supply and 98980 covers treatment management time. They serve distinct functions and can be billed together when each code's criteria are independently met.

07What device qualifies for billing 98975?

The device or software platform must meet the FDA definition of a medical device. Most certified therapy apps and wearables designed for data transmission qualify. Document the specific product name — generic references to 'an app' are an audit flag.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the RTM setup session from dictation: the device or app name and version, step-by-step instructions given to the patient, confirmation of patient understanding, and the date monitoring began. It also flags whether the therapy plan of care is linked and prompts for the correct discipline modifier (GP, GO, or GN). That prevents the two most common denials for 98975 — missing plan-of-care linkage and an undocumented setup encounter.

See how Mira captures CPT 98975 documentation