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RTMBase2026 Compliant

CPT 98976

2026 Billing Guide

RTM Device Resp 16+ Days

Reimbursement

$47.06

Threshold

16d

2026 Status

Active

What is CPT Code 98976?

CPT 98976 is defined as: Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days.

This code is primarily used for RTM services. It falls under the category of Remote Therapeutic Monitoring (RTM) and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.

2026 RVU Components

Relative Value Units (Non-Facility)

Standard Formula Applied

Work RVU

0

Physician Effort

PE (Non-Fac)

1.41

Practice Expense

Malpractice

0

Risk Factor

Total RVU

1.41

Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor

2026 CMS Policy Intelligence

short duration fallback

CMS 2026 introduced new codes (e.g., 99XX5) for 2 to 15 days of RTM data. Use 98976 ONLY for 16+ days.

efficiency shield

Protected from the -2.5% productivity adjustment (Work RVU is 0.0).

fqhc rhc transition

FQHCs must now bill 98976 directly instead of using the single flat rate of G0511 for RTM supply.

Administrative Framework

Place of Service

11 (Office)12 (Home)22 (Outpatient Hospital)

NCCI Exclusions

Do not bill with:994549897799XX5G0511

Key Modifiers

G2211Applicable to the office visit; 98976 provides the respiratory adherence data necessary for managing longitudinal complexity.

Operational Requirements

minimum data days

16 days of recordings/transmissions within a 30-day period.

frequency

Once every 30 days

system focus

Must be for monitoring the respiratory system.

device type

FDA-cleared medical device required.

automated transmission

Data must be transmitted automatically (e.g., smart inhaler cloud sync).

Compliance Checklist

Transmission log showing at least 16 days of successful data sync
Documentation of the specific respiratory equipment being monitored
Linkage to the therapeutic plan of care

Audit Defense

respiratory attribution

Ensure for-audit purposes the record clearly distinguishes this as a respiratory device, not a generic physiologic monitor.

no overlap

Cannot be billed concurrently with 98977 (MSK) for the same patient in the same month.

2026 Update

The 16-day rule remains the primary cause of RTM audit recoupments. Automated system checks for day count (16 vs 2-15) are essential.

Common Clinical Scenarios

COPD patient (J44.9) monitor inhalation technique and frequency to adjust rescue inhaler dependency.
Asthma patient (J45.909) tracking daily peak flow and trigger-responsive medication use.
Cystic fibrosis patient monitoring daily airway clearance therapy response.

Target Specialties & Utilization

PulmonologyRespiratory TherapyPrimary Care

Typical Clinical Indications (ICD-10)

J44.9 (COPD)J45.909 (Asthma)J47.9 (Bronchiectasis)E84.0 (Cystic fibrosis)

Frequently Asked Questions

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