RTM in 2026: FAQs Answered by the Experts
Part 3 of the RTM Implementation Playbook Series
RTM is one of the biggest opportunities in outpatient PT right now, but it’s also one of the most misunderstood. Between understanding the new 2026 RTM CPT codes and the operational lift of actually running a program, it’s no surprise that practice owners have questions.
That’s exactly why we brought together Ben Barron, SVP of Sales at Limber Health, Rick Gawenda, Founder & President of Gawenda Seminars & Consulting, and Craig Brasington, VP of Revenue at Stride, for a live webinar on how smart practices are doing RTM differently in 2026.
The conversation sparked a lot of great questions from attendees—more than our panelists could get to in the time we had. So we’ve compiled the top questions from the live Q&A, plus a few we didn’t get to, and answered them here.
In case you missed it, watch the webinar here, or get the key takeaways in Part 1 and Part 2 of this blog series.
Billing, Coding, and Compliance Questions
What revenue cycle mistakes do you see therapy practices make when implementing RTM, and how can they proactively avoid denials and compliance issues?
As Rick Gawenda, PT, explained on the webinar, the most common RTM billing mistake he sees is mis-timed submissions. RTM codes don’t all follow the same billing interval. Some are billed every 30 days, others at the end of a calendar month, and practices doing their own billing often get those mixed up.
"Unfortunately, they didn't make this easy in terms of when the CPT codes get billed," Gawenda said. "They get billed at different times, different intervals."
Codes 98979, 98980, and 98981 are billed per calendar month, while others follow a 30-day period from the start of monitoring. Submitting before those windows close is one of the most common, and easily avoidable, mistakes.
On the denial side, Gawenda noted that outright denials are relatively rare when billing to payers that cover RTM. Most denials come from submitting to commercial insurers that haven’t yet adopted RTM reimbursement, not from billing errors themselves.
The best defense on both fronts is technology. A good RTM platform will track billing windows automatically, flag when codes are ready to submit, apply the correct modifiers, and ensure documentation supports each claim before it goes out the door.
Craig Brasington put it simply: "How do I know who's met what, when? This is where technology can keep its finger on that and make sure you know when."
If you’re just getting started, Rick’s recommendation is to begin with original Medicare. It has the clearest reimbursement policies, has covered RTM codes since 2022, and gives you a clean runway to build your billing workflow before navigating commercial payers.
Which commercial payers are consistently reimbursing RTM today, and which are still limiting or denying coverage? Is Medicare the primary payer you are finding success with RTM codes?
According to Gawenda, Medicare is the most straightforward RTM payer and the best place to start. The coverage policies are clear, the codes have been reimbursable since 2022, and there’s no ambiguity around which codes apply or when to bill them.
On the Medicaid side, more than 26 states are currently reimbursing for RTM. APTA members can download the Medicaid physician fee schedule directly from the APTA website, which includes the RTM codes.
Beyond Medicare, the commercial payer landscape is growing but inconsistent. Aetna and UnitedHealthcare are reimbursing in many markets, and a number of Blue Cross plans around the country have adopted RTM coverage as well.
The complexity, as Ben Barron noted, is that private insurance is a state-by-state game. A Blue Cross plan that reimburses in one state may not in another, and payer policies can shift quickly.
He recommended partnering with an organization that tracks payer policies at scale:
"We’re [Limber Health] working with our clients every day around this sort of stuff, and we're seeing really interesting data come back,” Barron explained. “We certainly have really good research on positive payment policies by payer throughout the country, as well as frankly negative payment policies where there have been payers that have come out and said, no, we do not reimburse for this.”
There is also a middle group of payers that haven’t made a formal statement either way. Barron’s team has developed strategies to help practices determine whether a payer’s silence means they won’t pay, or whether they simply haven’t established a policy yet, which is a very different situation.
Do you have any data on denial rates, reimbursement challenges, or claim rejection rates associated with RTM CPT codes?
The panelists didn’t have specific data on denial rates or claim rejections. Anecdotally, though, their experience is that RTM denials with Medicare are rare. When they do occur, having a partner like Limber Health in your corner makes a difference. They’re able to walk practices through the documentation needed to support resubmission.
This is another reason Rick Gawenda recommends starting with Medicare beneficiaries when you’re new to RTM. Compared to Medicaid and commercial payers, the path to reimbursement is more straightforward.
Initial setup 98975. Is this a timed code?
No, 98975 is not a timed code. It’s billed once per episode of care after the patient has logged at least two days of activity in the monitoring period. What matters for 98975 isn’t time spent, but documentation. You’ll want to clearly document that you provided the device or app, educated the patient or caregiver on how to use it, and outlined their exercise protocol, including what to do, what data to track, and how often to do so.
Staffing and Operations Questions
If you are using staffing Model 2, do you have an approximate amount of time you need to plan weekly for your dedicated RTM therapist per PT volume enrolled in RTM?
There’s no universal benchmark, as time requirements vary depending on patient engagement levels, the complexity of cases, and how your RTM program is structured. That said, the time investment includes logging into patient accounts, reviewing transmitted data, updating RTM programs, communicating with patients, and documenting provider interactions. Gawenda recommends logging in at least three times per week per patient.
As a general starting point, practices using staffing Model 2 should plan for dedicated RTM hours proportional to enrollment volume, and build in a buffer for the interactive communication requirement, which is, at minimum, one synchronous phone or video call per patient per calendar month. If your enrollment grows faster than anticipated, that’s often the inflection point where practices consider transitioning to Model 3.
We have a large work comp following. I see RTM being very useful in this population. Are you aware of any reimbursement in the work comp segment?
Workers’ compensation reimbursement for RTM is not something the panelists had specific data on, as workers’ comp is governed at the state level and varies significantly by jurisdiction and carrier. However, a handful of practices Limber Health works with have expressed confidence that their workers’ comp contracts would cover RTM, so it’s certainly worth exploring.
Is there a current metric or industry standard for the percentage of patients per payer of your caseload that are enrolled in RTM?
There’s no established industry benchmark for RTM enrollment rates. The right target for your practice depends heavily on your payer mix. Starting with your Medicare population gives you the clearest path to measurable results, and you can expand from there as you confirm coverage with commercial and Medicaid payers in your market.
