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RTMAdd-on2026 Compliant

CPT 98981

2026 Billing Guide

RTM Mgmt Add-on 20 min

Reimbursement

$41.80

Threshold

20m

2026 Status

Active

What is CPT Code 98981?

CPT 98981 is defined as: Remote therapeutic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure).

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

0.61

Physician Effort

PE (Non-Fac)

0.6

Practice Expense

Malpractice

0.04

Risk Factor

Total RVU

1.25

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

2026 CMS Policy Intelligence

threshold reduction

CMS 2026 officially reduced the additional time threshold to 10 minutes (matching RPM consistency).

efficiency shield

Protected from the -2.5% productivity adjustment (Time-based care management service).

revenue impact

Allows therapists to capture revenue for mid-length sessions (e.g., 30 minutes) which were previously difficult to bill in larger 20-minute buckets.

Administrative Framework

Place of Service

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

NCCI Exclusions

Do not bill with:99458G0511

Key Modifiers

95Telehealth modifier for the required interactive communication.
G2211Applicable to the primary visit, supporting the longitudinal complexity that requires extra RTM time.

Required Primary Codes

Must be billed alongside a primary service.

Operational Requirements

minimum time

Each additional 10 minutes (Threshold starts at 30, 40, 50... total RTM minutes).

primary code

98980 (Must be billed for the first 20 minutes).

staff type

Clinical staff, physician, or QHP (including PT/OT/SLP) under general supervision.

stacking rule

Can be billed with multiple units for each additional 10-minute block.

Compliance Checklist

Total monthly RTM time must exceed the aggregate threshold (e.g., 30 mins for 1 unit of add-on)
Documentation of clinical activities for each time block
Consistency with 98980 interactive communication requirements

Audit Defense

minute by minute log

Audit logs must show incremental accumulation of time. 'Reviewing data' entries must be accompanied by the required interactive component in the base 20 mins.

therapist attribution

Clearly document the PT/OT/SLP name and time spent to justify therapist-level RTM billing.

2026 Update

The 10-minute rule is a major change from previous 20-minute expectations. EMRs must be updated to trigger at the 30-minute cumulative mark.

Common Clinical Scenarios

Physical therapist spending 35 minutes managing a complex post-op rehab patient (Bill 98980 + 1 unit of 98981).
Respiratory therapist spending 45 minutes coordinating COPD therapy and adherence across multiple sessions (Bill 98980 + 2 units of 98981).

Target Specialties & Utilization

Physical TherapyOrthopedicsPulmonology

Typical Clinical Indications (ICD-10)

M54.5 (Low back pain)J44.9 (COPD)M17.11 (Knee osteoarthritis)

Frequently Asked Questions

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