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Hana Health
Care ManagementOctober 26, 2026

RPM vs RTM: What's the Difference for Medicare Billing?

Matteo

Updated October 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

Remote physiologic monitoring (RPM) tracks physiologic readings such as blood pressure, weight and pulse oximetry that a device uploads automatically. Remote therapeutic monitoring (RTM) tracks how a patient responds to a treatment, like therapy adherence or respiratory and musculoskeletal status, and can include patient reported data. In 2026 Medicare's national payment for a typical month of either service is roughly $94 to $102.

As a clinical psychologist, I find RTM the easier one to explain: it asks what the patient does with a treatment, not only what a device reads.

Key facts

What is the difference between RPM and RTM?

The difference is the kind of data and the question it answers. RPM monitors physiology to manage an acute or chronic condition. RTM monitors the therapeutic side: whether the patient is following a treatment and how they're responding to it.

Both services use the same three part structure. There's a setup and education step, a device supply step that depends on how many days of data came in, and a monthly treatment management step that depends on clinician time and a live conversation with the patient.

In practice, a connected blood pressure cuff for a patient with hypertension is RPM. A connected device that tracks a patient's home exercise program after a knee procedure, or a respiratory therapy device, fits RTM. The CPT codes are different, so the claim has to match what's actually being monitored.

One more practical point. The American Physical Therapy Association notes that physical therapists providing therapy under Medicare Part B can bill the RTM codes, which is a big reason RTM has a different user base than RPM. Check APTA's practice advisory for the profession specific details.

What data does each service monitor?

RPM monitors physiologic data. Think weight, blood pressure, pulse oximetry, glucose and respiratory flow rate. The device has to meet the FDA definition of a medical device, and the data has to be collected electronically and uploaded automatically.

RTM monitors nonphysiologic data tied to a treatment. That includes musculoskeletal system status, respiratory system status, therapy adherence and therapy response. HHS notes that RTM data can be self reported by the patient, which RPM data can't.

That one rule changes the workflow. With RPM, a patient who writes a reading on paper and phones it in doesn't create billable data. With RTM, a patient who logs pain or exercise completion in an app on a qualifying device can.

The AASM guide adds a caution worth keeping: CMS hasn't issued explicit, service specific guidance on consent for RTM, so it recommends documenting consent before furnishing any remote monitoring service. That's good practice for both.

Which codes does each service use?

Each service has one setup code, device supply codes and two treatment management codes. Here's the code by code view, using the 2026 national payment amounts.

  • 99453 (RPM setup): setup and patient education on the equipment. $21.71, billed once per episode of care.
  • 99454 (RPM device supply): device supply with daily recordings or alerts, 16 to 30 days in a 30 day period. $47.43.
  • 99457 (RPM management): first 20 minutes of treatment management in a calendar month, with at least one real time interactive communication. $51.77.
  • 99458 (RPM add on): each additional 20 minutes. $41.42.
  • 98975 (RTM setup): setup and patient education. $21.71, once per episode of care.
  • 98976 (RTM respiratory device supply): 16 to 30 days in a 30 day period. $47.43.
  • 98977 (RTM musculoskeletal device supply): 16 to 30 days in a 30 day period. $40.08, down from $43.02 in 2025.
  • 98978 (RTM cognitive behavioral therapy device supply): contractor priced in 2026, so there's no national amount.
  • 98980 (RTM management): first 20 minutes in a calendar month, with at least one interactive communication. $54.11.
  • 98981 (RTM add on): each additional 20 minutes. $41.42.

Source for the amounts: the AASM payment comparison, which uses the 2026 conversion factor of $33.4009.

CMS also finalized new codes for CY2026: a device supply code for 2 to 15 days of data (99445 for RPM, 98984 to 98986 for RTM) and shorter management codes for 10 to 19 minutes (99470 for RPM, 98979 for RTM). The Federal Register final rule lists them, and a Nixon Law Group summary explains how they work. They can't be billed in the same 30 day period as the 16 day device codes.

How much does Medicare pay for RPM and RTM in 2026?

A typical month pays about $94 to $102 per patient. Here's the arithmetic, using the national amounts above and no local adjustment.

A month of RPM with 16 or more days of data and 20 minutes of management:

  1. 99454 device supply: $47.43
  2. 99457 first 20 minutes: $51.77
  3. Total: $99.20

Add a second 20 minutes with 99458 ($41.42) and the month reaches $140.62.

A month of RTM for a musculoskeletal program:

  1. 98977 device supply: $40.08
  2. 98980 first 20 minutes: $54.11
  3. Total: $94.19

The same month for a respiratory program uses 98976 ($47.43) instead, so the total is $101.54.

Setup is separate. 99453 and 98975 pay $21.71 once per episode of care.

These are national averages, not guarantees. Your payment depends on your locality, and a month only counts if every requirement is met and documented. The CY2027 proposal would also lower the setup and device values if it's finalized, so treat 2026 numbers as 2026 numbers.

Can you bill RPM and RTM for the same patient?

No. HHS guidance says remote physiologic monitoring and RTM can't be billed together. Only one practitioner can bill RPM per patient in a 30 day period too.

Either service can sit next to some other care management programs. HHS says RPM or RTM, but not both, may be billed in the same period as chronic care management, transitional care management, behavioral health integration and principal care management, as long as time isn't counted twice.

The AASM guide gives the same warning for RTM management time: document each service's minutes separately, and don't let one minute count toward two codes in the same calendar month.

That's why the clinical question comes first. If the data is physiologic, you're in RPM territory. If it's a therapy adherence or response question, RTM may fit. Picking the code for the revenue instead of the data type is where audits start. For the RPM side in depth, see our guide to RPM billing requirements for 2026.

What does the CY2027 proposal change for RPM and RTM?

It changes both services, and it's still a proposal. CMS released the CY2027 Physician Fee Schedule proposed rule on July 14, 2026, and the Federal Register published it on July 16 (91 FR 43842). Comments closed on September 14. As I write this, the final rule isn't out, and it usually lands in early November.

If it's finalized as proposed, starting January 1, 2027:

  • Clinical staff time would count only when the staff are direct employees of the billing practitioner or practice. Staff could work remotely under general supervision, per Nixon Peabody's summary.
  • Both services would need a separately billable face to face initiating visit where monitoring is actually discussed.
  • RTM would need an established patient relationship, like RPM already does.
  • CMS also proposes lower practice expense values and asked for comment on replacing the current codes with new G codes.

Practices could still buy technology and software from vendors. What changes is who can furnish the billable clinical work. Our separate explainer covers which programs are exposed and which aren't.

What this means for your practice

Start with the clinical use case, then pick the service. Decide whether the data is physiologic or therapeutic, confirm you have an established patient relationship, and document consent before the first reading.

Next, build the monthly checklist: days of data, minutes, one real conversation with the patient, and who did the work. If you rely on an outside company for monitoring staff, map that arrangement now against the CY2027 proposal so you aren't rewriting a program in December.

Also keep the OIG findings in mind. Of the enrollees OIG studied in 2022, 43% missed at least one component, and OIG flagged practices that billed with no prior patient relationship. Clean setup and management documentation is your best protection.

HANA helps practices run patient outreach and follow up between visits so staff can spend their time on the clinical work that actually gets billed. You can read more on our remote care page.

Frequently asked questions

Is RTM easier to bill than RPM?

It's different, not easier. RTM currently doesn't require an established patient relationship and can use self reported data, but the CY2027 proposal would add an established patient rule and an initiating visit. Treatment management still needs the clinician time and a live conversation either way.

Do RPM and RTM both need 16 days of data?

The device supply codes do. 99454, 98976, 98977 and 98978 need data on at least 16 days in a 30 day period. The treatment management codes don't use that day count. CY2026 added separate device codes for 2 to 15 days of data.

Can a physical therapist bill RTM?

Yes, according to the APTA, physical therapists providing therapy under Medicare Part B can bill the RTM codes. Documentation should tie the monitoring to the plan of care and its goals.

What counts as interactive communication for RPM and RTM management?

The AASM guide describes it as a real time, synchronous, two way audio interaction, which can be enhanced with video. At least one is required in the calendar month for the treatment management codes.

Will the CY2027 rule end RPM and RTM?

Not as proposed. CMS isn't proposing to eliminate payment for the services. It would limit who can furnish the clinical work and tighten visit rules. The final rule decides what survives.

Sources

  1. American Academy of Sleep Medicine, Remote Monitoring Services Implementation Guide, 2026. aasm.org
  2. Telehealth.HHS.gov, Billing for remote patient monitoring, 2025. telehealth.hhs.gov
  3. American Academy of Sleep Medicine, 2025 and 2026 Telemedicine Payment and RVU Comparison, 2025. aasm.org
  4. CMS, Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule, Federal Register, 2025. federalregister.gov
  5. CMS, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule, Federal Register, 2026. federalregister.gov
  6. HHS Office of Inspector General, Billing for Remote Patient Monitoring in Medicare, data snapshot, 2025. oig.hhs.gov
  7. HHS Office of Inspector General, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed, 2024. oig.hhs.gov
  8. American Physical Therapy Association, Practice Advisory: Remote Therapeutic Monitoring Codes Under Medicare, 2025. apta.org
  9. Nixon Law Group, CMS Finalizes 2026 Remote Monitoring Reimbursement Updates, 2025. nixonlawgroup.com
  10. Nixon Peabody, Medicare proposes significant changes to remote patient monitoring and remote therapeutic monitoring services, 2026. nixonpeabody.com

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill.

If you want to talk through how remote monitoring fits your practice, you can book a discovery call.