The world of remote therapeutic monitoring (RTM) is becoming more flexible and aligned with real-world clinical practice, due to key updates from the Centers for Medicare & Medicaid Services (CMS) for Calendar Year (CY) 2026. A part of this evolution is the introduction of RTM CPT code 98985. For musculoskeletal (MSK) care teams, new CPT code 98985 is a vital addition. It allows reimbursement for the valuable, shorter care management interactions that were often previously uncompensated. This article will explain guidelines and 2026 rate for CPT code 98985.
What is RTM CPT Code 98985?
CPT code 98985 is the new code specifically designed to capture the treatment management time provided by clinical staff, physicians, or other qualified health care professionals when the total time spent in a calendar month is less than the 20-minute threshold required by the existing CPT code 98980.
Here is the essential breakdown of CPT code 98985:
- Service Covered: Remote therapeutic monitoring treatment management services. This includes reviewing non-physiologic data (such as therapy adherence or pain levels), communicating with the patient/caregiver, and making clinical decisions.
- Time Requirement: The code covers the first 10–19 minutes of cumulative time spent in a calendar month.
- Mandatory Component: It requires at least one real-time, interactive communication with the patient or caregiver during the calendar month.
- Billing Frequency: CPT code 98985 can be billed once per calendar month per patient.
This code effectively fills the gap created by the 20-minute minimum for CPT 98980, acknowledging that short, targeted clinical touchpoints are essential for effective therapeutic monitoring and recovery.
The Clinical and Financial Value
The ability to bill for shorter time increments directly improves your program’s efficiency and patient care quality. Many critical RTM services, such as checking in on a patient’s range-of-motion progress or inhaler technique—don’t require a full 20 minutes of staff time.
CPT code 98985 allows you to capture reimbursement for:
- Quick Progress Checks: A 12-minute synchronous call with a physical therapy patient to discuss pain levels during home exercises and adjust their activity plan.
- Adherence Troubleshooting: A quick, interactive check-in to assist a patient struggling with their respiratory device, falling short of the 20-minute mark.
- Treatment Adjustments: Time spent reviewing therapeutic data and then engaging in a brief, live interactive communication to modify a patient’s care goals.
Clinical staff can now focus on providing high-quality, targeted care without the pressure of needing to meet a minimum 20-minute threshold for every patient interaction. This flexibility can lead to reduced burnout and increased capacity for providers to manage larger patient panels.
Billing and Compliance Rules for CPT Code 98985
Proper billing under the new rules requires meticulous time tracking and adherence to specific guidelines:
| CPT Code | Service Description | Time Requirement (Monthly) | Interactive Communication | Billing Rule |
| 98985 (NEW) | RTM Management Services | 10–19 minutes | Required (at least one) | Mutually Exclusive with 98980/98981 |
| 98980 (Existing) | RTM Management Services | First ≥ 20 minutes | Required (at least one) | Cannot be billed with 98985 |
| 98981 (Existing) | RTM Management Services | Each additional 20 min | N/A (follows 98980) | Billed as add-on to 98980 only |
The average national payment rate for 98985 is $40.00.*
Rates are based on non-facility national averages and vary by region.
Compliance Checklist
- Mutual Exclusivity: You must choose either CPT code 98985 (10-19 min) or CPT code 98980 (≥ 20min) in a given calendar month, but not both.
- Interactive Communication: A non-negotiable requirement. The communication must be real-time and synchronous (e.g., phone call, video chat). Secure messaging or voicemails alone do not qualify.
- Documentation: Your RTM platform and EHR must clearly document the cumulative minutes spent, the date/method of communication, and the clinical necessity of the services.
- Non-Duplication: Time billed under CPT code 98985 cannot be counted toward other time-based codes like CCM or other E/M services.
The adoption of CPT code 98985 is a definitive step toward making RTM sustainable and profitable across a wider array of clinical scenarios. It rewards efficiency and recognizes the value of brief, timely clinical interventions.
