Is there patient responsibility for RTM CPT codes?
Potentially yes. RTM codes behave like any other CPT codes: if the patient hasn't met their deductible, or has co-insurance, there can be financial patient responsibility. This is unique per insurance plan, and there is typically no way to know at the patient level before billing. Patients are most comfortable with the charges when providers actively use the RTM data in their care.
Can 98975 be billed immediately at the evaluation?
No. The patient must be monitored for at least 2 days, and SaRA additionally requires the same cycle to earn a monitoring code before it will generate a 98975 — see RTM CPT codes & billing thresholds.
What are the time requirements for the Support codes (98979/98980/98981)?
98979 requires 10-19 minutes of logged interaction in a calendar month. 98980 requires 20-39 minutes (a combination of data review and synchronous interaction). 40-59 minutes achieves 1 unit of 98980 plus 1 unit of 98981, and each additional 20 minutes in the month adds another unit of 98981. Full criteria and case examples: RTM CPT codes & billing thresholds.
Why didn't I get an email about the Support code like I do for other codes?
There is no automated email for Support code awareness because Support codes always become billable at the end of a calendar month. Check the Billing page in SaRA.
If a patient replies STOP, can we still bill 98980 if we reached 20 minutes?
No. When a patient replies STOP they are considered inactive and SaRA no longer evaluates them for billable events.
Can I log an interaction while also collecting time for an in-person code (like manual therapy)?
No. Just as you cannot bill two treatments simultaneously, time logged for RTM must be designated to only that interaction.
Does all logged time need to be clinical reasoning time?
Ideally all logged time supports the patient's care in some way — this can include arranging appointments or discussing the care with another provider, as long as an RTM response was the initial motivation. Example: a patient's message motivates you to call their primary care physician — that time is appropriate to log.
What Place of Service code should we use?
Use PoS 11 (office), because the software is "stored" at your office. Mobile clinics also see the best success with 11.
Do RTM codes count toward daily CPT limits (e.g., 4 codes per day)?
By the coding classification, no — RTM codes are "sometimes therapy," which generally places them outside daily limits on dollar amount or codes per day.
We treat this as the general rule rather than a guarantee. Payer behavior in the real world does not always follow the classification, and we are actively checking our own remit data against it. If you see RTM codes counted against a daily limit, send us the remit through the in-app chat — that evidence is genuinely useful to us and we will work the payer with you.
What is the difference between "always therapy" and "sometimes therapy" codes?
"Always therapy" codes must always be billed under a PT/OT/SLP plan of care with the appropriate therapy modifier (GP, GO, or GN) — for example, eval/re-eval codes 97161-64 and 97165-68.
"Sometimes therapy" codes (including RTM) can be billed by physicians/NPPs outside a therapy plan of care without a therapy modifier; when provided by a therapist they are treated as "always therapy" and require the modifier.
That is the classification as written. In practice we have seen individual payers apply it inconsistently, so if a claim is denied in a way that contradicts the above, tell us rather than assuming the denial is correct.
Is RTM available for out-of-network patients?
Clinically and from a coding standpoint, yes — RTM applies to both in-network and out-of-network patients.
What SaRA bills: SaRA's in-house billing submits in-network claims only. Clinics that bill for themselves may bill RTM for out-of-network patients under their own payer contracts.
Does the CQ modifier apply when a PTA bills the codes?
Yes, when the PTA performed the service. It still applies if the PT did the services but the PTA billed them. Conversely, if the PTA logs the interaction but the PT bills it, the modifier does not apply. There should be no assistant reduction for 98975 and 98977.
The PTA must have their own NPI to bill under. If your assistants do not have NPIs yet, sort that out before routing RTM work to them.
Are RTM codes timed or untimed?
98975 and all six monitoring codes — 98976, 98977, 98978, 98984, 98985, 98986 — are untimed. If your EMR requires a time entry, enter 1 minute.
98979/98980/98981 are timed: 98979 requires ≥10 minutes in a calendar month; 98980 requires ≥20 minutes of RTM review plus a synchronous interaction; 98981 covers each following 20-minute increment.
How do I monitor whether RTM claims are getting paid?
If SaRA handles your billing: we see the claims we submit and the remits that come back to us, and your Billing page carries the Submitted and Closed tabs so you can follow where a claim stands. Ask us any time for a read on how a payer is behaving.
If you self-bill: SaRA cannot see payer remits inside your EMR. You or your biller should run an RTM reimbursement/claims report in your EMR or clearinghouse to confirm which RTM codes were paid over a cycle (often ~30 days).
Either way, if you see a large gap between SaRA-delivered billable events and paid claims, send us the report through the in-app chat so we can investigate.
How do I bill in my EMR? Where does the justification go?
You can bill RTM codes as part of a typical daily visit note (like any other CPT code, adding the justification SaRA provides), or as a non-visit note/encounter. See Billing RTM in my EMR? for step-by-step guides per EMR.