Only one practice can be paid for a patient's RTM in any 30-day period. If another practice or another monitoring program is already billing RTM for a patient, your claims for the same period will not pay, so the time to sort this out is at enrollment.
The rule, code by code
Medicare's payment rules treat remote therapeutic monitoring as one service per patient, not one service per practice. The same limits apply whether the other party is a different clinic, a surgeon's office, or a monitoring program your own practice already uses.
Codes | What they cover | The limit |
98975 | Setup and patient education | Once per episode of care. |
98977 | Monitoring for the 30-day cycle | One practitioner per patient per 30-day period. |
98980 and 98981 | Reviewing the data and talking with the patient | One practitioner per patient per 30-day period. |
Two more points from the same rules. RTM and remote patient monitoring (RPM, the device-based cousin) cannot be billed for the same patient in the same period. And when two practices both bill, the payer pays the claim it processes first and denies the other, so there is no way to split a month.
The full criteria for each code are in RTM CPT codes and billing thresholds (2026).
The three situations clinics ask about
Another practice is already monitoring the patient for the same problem. A patient recovering from a knee replacement may already be on the surgeon's monitoring program. If that office is billing RTM, your RTM claims for the same weeks will deny. You can still enroll the patient so they get check-ins and you see how they are doing between visits. Just enroll them without billing, using the steps in Enrolling a patient without billing them.
The other practice's monitoring has ended. If the patient was discharged from the other program, or that plan of care is complete, a new episode of care can begin with you. Enroll them as usual. When SaRA asks whether this is a new plan of care, answer Yes, so the setup code is generated for your episode.
Your own clinic already uses another monitoring program for this patient. Pick one program per patient. Running two for the same patient earns one payment, not two, and creates duplicate claims your biller then has to unwind.
If a claim already denied for this reason
A denial that reads as a duplicate or a frequency limit, on a patient whose yearly therapy dollars are nowhere near the Medicare threshold, usually means another practitioner billed RTM for that patient first. Confirm with the patient who else is monitoring them, then decide which practice keeps billing going forward.
If SaRA bills for you and you are not sure why a claim denied, message us through the in-app chat with the patient's initials and the date of service and we will read the payer's response with you.