Payment Timing — Pure FFS, Monthly Claim, No Withhold
RTM payments are per-claim, per-patient, per-month. There is no withhold and no quarterly reconciliation. Each CPT code is billed independently for the patient-month and paid at the 2026 PFS national average within ~14–30 days under standard MAC claims processing.
Unlike ACCESS or other value-based programs, there are no quarterly spikes or dips — the chart above is smooth because cash flow is smooth. Volatility comes entirely from the composition of patient-months: how many patients hit which engagement thresholds. RTM-MSK volatility is dominated by post-op episode timing: PTs front-load device-days in the first 6 weeks; weeks 7–12 shift toward Management-Only Track.
Per-Code Rates — 2026 PFS National Average
Rates below are CY 2026 Medicare PFS national average non-facility, $33.40 base conversion factor (or $33.57 for qualifying APM participants). Geographic locality adjustments (GPCI) move rates ±5-15% by region; commercial payers vary widely (~70-130% of Medicare). Chicagoland GPCI runs ≈101% of national average, so the rates shown apply nearly verbatim.
| CPT | Description | Period | 2026 Rate | Threshold |
|---|
| 98975 | RTM device setup & patient education | One-time per episode | $20 | Consented + device delivered |
| 98977 | RTM device supply, MSK (wearable sensor) | 30-day period | $40 | ≥16 device-days |
| 98985 NEW 2026 | RTM device supply, partial (MSK) | 30-day period | $36 | 2–15 device-days |
| 98980 | RTM treatment mgmt, first 20 min | Calendar month | $54 | ≥20 min + live comm |
| 98981 | RTM treatment mgmt, add-on 20 min | Calendar month | $41 | Each additional 20 min, attaches to 98980 only |
| 98979 NEW 2026 | RTM treatment mgmt, brief (stand-alone) | Calendar month | $26 | 10–19 min · NO add-on possible |
| RPM (reference only — disjoint cohort, see CALC-08) |
| 99453 | RPM device setup | One-time per episode | $22 | Consented + device shipped |
| 99454 | RPM device supply (BP cuff, scale, etc.) | 30-day period | $52 | ≥16 device-days |
| 99457 | RPM mgmt, first 20 min | Calendar month | $52 | ≥20 min + live comm |
| 99458 | RPM mgmt, add-on 20 min | Calendar month | $41 | Each additional 20 min |
Sources: Tenovi 2026 RTM codes ·
nSight Care 2026 RPM/RTM guide ·
CMS CY 2026 PFS Final Rule.
Add-On Logic (98981)
98981 stacks on 98980 (NOT on 98979). A patient who gets 40 minutes of treatment management generates 98980 + 98981 = $54 + $41 = $95 just for mgmt. RTM-MSK operators leave more 98981 on the table than RPM operators leave 99458 — PT/OT staff are less familiar with the 20-min documentation rule. The add-on slider models how aggressively the clinical team documents the second 20-min block.
For MotionPath's current panel, moving the add-on slider from 45% to 85% — a documented best-practice intervention — is worth an additional ~$10K/month at steady state without enrolling a single new patient (computed live from the current mgmt slider, which determines how many patients qualify for 98980). This is the management-discipline lever.
New 2026 Codes & Mutual Exclusivity
The CY 2026 PFS Final Rule introduced two new RTM codes: 98985 (partial-device, 2–15 days, $36) and 98979 (brief mgmt, 10–19 min stand-alone, $26). Both are mutually exclusive with their full-credit siblings — a single patient-month can bill either 98977 or 98985, never both. Same for 98980 vs 98979. Critically, the 98981 add-on attaches ONLY to 98980, not to 98979.
RTM's distinguishing structural feature: ~50% of pt-mo are management-only (no billed wearable device), driven by PT/OT panels where many post-op patients hit 20 mgmt-minutes but don't wear a sensor. At the current sliders, mgmt-only buckets contribute roughly ~50% of patient-months and ~$355K/year at the panel size shown. The 20-minute mgmt threshold remains the highest-leverage operational target.
RPM Stacking — Out of Scope
RTM and RPM cannot be billed concurrently for the same patient in the same calendar month for the same condition (CMS dual-billing rule, see CMS Internet-Only Manuals). RPM revenue therefore does not stack onto an RTM-MSK panel — it would require a separate, disjoint patient cohort with a different qualifying condition (typically HTN, HF, or other chronic).
MotionPath's MSK focus means most enrolled patients do not qualify for RPM anyway: an RPM patient needs a physiological signal (BP, weight, glucose) tied to a chronic condition, not the orthopedic outcome measures (Oxford, KOOS, QuickDASH) that drive PT/OT episode billing. Modeling a disjoint RPM cohort cleanly requires its own enrollment, eligibility, device-day, and time-log streams, which is outside the scope of this calculator.
RPM rates are kept in the CALC-02 reference table for completeness, but no RPM revenue is included in the chart, the headline metrics, or the projection.
If you need RPM revenue modeling for the MotionPath panel's small chronic-disease overlap, build it as a parallel calculator with its own (disjoint) panel, not an addition to this one.