98981 CPT Code reflects remote therapeutic monitoring. It is an ad-on code that requires 20 minutes of non-face-to-face interaction with patients within a calendar month. Healthcare providers can only bill this code after an initial 20 minutes billed under parent code 98980.
Over time, the need and demand for the telehealth services is increasing. As per AMA (American Medical Association) More than 80% of physicians say telehealth improves timely access to care.
CMS introduced these codes to encourage remote patient monitoring and healthy lifestyle. Additionally, the average Medicare reimbursement amount is $41.42 per unit.
98981 CPT Code: Overview
98981 CPT is a Remote therapeutic monitoring add-on code that can be billed by physicians or other qualified professionals. As per the CMS, the base code is 98980, after which you can assign 98981 code for additional 20 minutes spent on patients within a month.
The contact should be in the form of a phone call or a video call. Emails, sms or chats do not qualify for this code. Moreover, billing both codes for the same patient only leads to claim denials and revenue loss.
Remote Therapeutic Monitoring Add-On Code
A remote therapeutic monitoring add-on code reports extra provider management time after the primary RTM service. It cannot be billed alone. Complete documentation and accurate time tracking are required to support reimbursement.
- What an RTM Add-On Code Means: An RTM add-on code reports additional provider work completed after the primary monthly RTM management service.
- Difference Between Primary and Add-On Codes: Primary codes start the billed service. Add-on codes report extra qualifying work performed after the primary code requirements are met.
- Why Accurate Time Tracking Matters: Accurate time tracking supports medical necessity, improves reimbursement, and reduces billing errors, audits, and claim denials.
- Practical Provider Example: A provider completes 40 management minutes monthly. Bill 98980 for the first 20 minutes and 98981 for the additional 20 minutes.
Who Can Bill CPT Code 98981
Only qualified healthcare professionals can billing this 98981 rtm add-on code. These include:
- Physicians
- Physical Therapists
- Occupational Therapists
- Speech Language Pathologists
- CMS recognized Licensed Clinicians
The 2026 final rule by CMS supports general supervision that allows physical and occupational therapists to offer general supervision for remote therapeutic monitoring outside the clinic territory. Which helps patients get access to quality care and enjoy a healthy life.
Only one provider can assign the RTM Codes (98979, 98980, and 98981) within a month. Even if the patient has been sent more than one medical device.
Requirements for 98981 RTM add-on Code
Understanding the 98981 cpt code requirements is crucial for providers to get timely reimbursement against the RTM services given to patients.
Documentation
Healthcare providers should document every 20-minutes of the interaction with the patient. The details should include date, time spent on reviewing the device data and decisions made. Yet again, the provider must assign 98980 for the first 20-minutes. Once the time exceeds to 40 minutes, the Remote therapeutic monitoring add-on code 98981 should be assigned.
In some cases, patient consent is also required by CMS. Therefore, record every single information to ensure a successful season and timely reimbursement.
Devices and Information
As per the CMS, the device given to patients should be approved by FDA (Food and Drug Administration). These devices are highly secure and protect patient information from outside theft. Patients use these devices and transmit data about their therapy adherence, daily routine and current health status.
Providers should evaluate the data and prepare a treatment plan. In simple words they should note that Patient reported PHQ-9 scores and adherence data from [AppName] were reviewed.
Communication
Healthcare providers are responsible to ensure a phone or a video call once in a 30-month time. As per the APTA, interaction between patient and provider should be virtual or physical, sms and emails do not qualify for this 98981 rtm add-on code.
If the patient interaction time remains between 10-19 minutes, providers cannot assign the code 98980. Therefore, meeting the criteria is important for the providers to get payments.
Time-Period
CPT 98980 Covers the first 20 minutes of the patient interaction within a calendar month. In case a provider spends 35 minutes, the code will be assigned for the 20 minutes rather than billing for the 40 minutes.
Suppose, you spent a complete one hour with the patient. Three sessions of 20 minutes each will be billed and submitted to the insurance payers for the reimbursement.
Documentation Requirements
Proper documentation is essential for accurate 98981 CPT code billing. Complete records support medical necessity and reduce claim denials. Every documented detail should connect to the patient’s care and remote monitoring activities.
Clinical Decision-Making
Explain the provider’s clinical decisions after reviewing patient information. Describe why each decision supported the patient’s treatment plan. Link every decision to documented clinical findings.
Treatment Changes
Document all treatment updates during the monitoring period. Include medication changes, therapy adjustments, or new home care instructions. State the reason behind each change.
Progress Notes
Write clear progress notes after every patient interaction. Describe symptom changes, treatment response, and current health status. Include the next steps in the care plan.
Device Data Review
Document the review of remote therapeutic monitoring device data. Summarize important trends, adherence, and abnormal findings. Connect the reviewed data to the provider’s clinical decisions.
Complete documentation strengthens compliance, supports reimbursement, and helps justify every billed RTM service. Clear records also make audits and payer reviews much easier.
Billing Guidelines
Correct billing helps providers receive proper reimbursement for the 98981 CPT code. Following payer rules also reduces claim denials and payment delays. Always review the latest billing requirements before submitting claims.
Add-On Code Rules
The 98981 CPT code is an add-on code. It cannot be billed alone. Providers must bill it with the primary RTM management code when all requirements are met.
Same-Date Claim Requirements
Bill the primary code and the add-on code on the same claim. Both services should reflect the same billing period. Documentation must support every reported service.
Frequency
Report 98981 CPT code only when the required additional management time is completed. Do not bill it more than allowed. Review payer policies before submitting repeat claims.
Medicare Considerations
Medicare requires complete documentation for every billed service. Providers should meet all time, communication, and medical necessity requirements. Missing records may result in denied reimbursement.
Common Payer Requirements
Many commercial payers follow Medicare billing rules. However, some plans have different coverage policies. Always verify payer guidelines before billing. Proper documentation improves claim approval and supports accurate reimbursement.
Reimbursement for 98981
Reimbursement for the 98981 CPT code depends on payer policies and complete documentation. Payment may vary between Medicare and commercial insurance plans. Accurate billing improves the chances of successful reimbursement.
CMS Medicare data for one physician assistant shows 274 reported 98981 services for 34 beneficiaries, with an average Medicare allowed amount of $33 and average Medicare payment of $26 per service.
Medicare Reimbursement Overview
Medicare reimburses eligible RTM services when billing requirements are met. Providers must document qualifying time, patient communication, and clinical management before submitting claims.
Factors Affecting Payment
Several factors can affect reimbursement. Missing documentation, coding errors, or unmet billing rules may reduce payment or lead to claim denials. Accurate records help support every billed service.
Commercial Payer Differences
Commercial insurance plans may have different coverage and reimbursement policies. Some payers follow Medicare guidelines, while others have their own billing rules. Always verify payer requirements before submitting claims.
Claim Denial Risks
Claims may be denied because of incomplete documentation, incorrect coding, or unsupported medical necessity. Reviewing records before submission helps reduce errors, improve reimbursement, and speed up the payment process.
98981 vs 98980
The 98981 vs 98980 comparison is simple. 98980 covers the first 20 minutes of monthly RTM treatment management. 98981 reports each additional 20 minutes after the initial service. Since 98981 is an add-on code, providers cannot bill it without 98980. Proper documentation is required for both codes.
| Feature | 98980 | 98981 |
| Purpose | Initial RTM treatment management | Additional RTM treatment management time |
| Time Requirement | First 20 minutes in a calendar month | Each additional 20 minutes after 98980 |
| Code Type | Primary RTM management code | Add-on RTM management code |
| Can Bill Alone? | Yes, if requirements are met | No, must be billed with 98980 |
| Billing Frequency | Once per calendar month | As allowed after qualifying additional time |
| Typical Use | First monthly provider management services | Extra provider management beyond the initial 20 minutes |
Conclusion
The 98981 CPT code is used for extra RTM treatment management time after the first 20 minutes billed with 98980. Using the right code, tracking provider time, and keeping complete documentation are all important for successful reimbursement. Following Medicare and payer rules also helps reduce claim denials and billing errors.
At MediRemote, we make RTM billing simple with accurate coding, complete documentation support, and reliable claim management. Our team helps providers improve reimbursement, stay compliant, and spend more time caring for patients.
FAQs
Can 98981 be billed without 98980?
No. 98981 is an add-on code. It must always be billed with 98980 after the required additional provider management time is completed.
How much additional time does 98981 cover?
The 98981 CPT code reports each additional 20 minutes of RTM treatment management after the first 20 minutes billed with 98980.
Is 98981 billed every month?
Yes, it can be billed once the monthly time requirements are met. Providers must also meet all documentation and payer billing requirements.
Does Medicare reimburse 98981?
Yes. Medicare may reimburse 98981 when billing rules, medical necessity, and documentation requirements are fully met. Payment depends on current Medicare policies.
What documentation is required for 98981?
Providers should document total time, patient communication, clinical decisions, treatment changes, progress notes, and device data review to support the billed service.
Can commercial insurance follow different billing rules?
Yes. Many commercial payers follow Medicare guidelines, but some have different coverage and reimbursement policies. Always verify each payer’s billing requirements.