CALC-01 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.
For each enrolled RTM patient, each calendar month:
bill_lines = []
IF first month after device delivery AND consented:
bill_lines += 98975 ($20, one-time per episode)
IF device_days >= 16: bill_lines += 98977 ($40) // MSK device
ELSE IF device_days in [2,15]: bill_lines += 98985 ($36) // NEW 2026
IF mgmt_minutes >= 20 AND live_interaction: bill_lines += 98980 ($54)
AND additional 20-min blocks: bill_lines += 98981 ($41) each
ELSE IF mgmt_minutes in [10,19]: bill_lines += 98979 ($26) // NEW 2026
monthly_revenue_patient = SUM(bill_lines)
org_monthly_revenue = SUM over all enrolled patients
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.
CALC-02 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.
CALC-03 Patient-Story Decomposition (RTM management-axis)
Every enrolled patient-month resolves to exactly one of seven archetypes shown in Section 01. Unlike RPM, RTM is management-axis primary: half of MotionPath's patient-months are billed without a device code at all (98980 stand-alone). Given the slider inputs (device-capture %, mgmt-completion %, add-on attach, growth %), the calculator distributes the enrolled population across these buckets using the conditional probabilities below.
Step 1 — Device tier (driven by device-code-capture slider d):
f_device_full = d // 98977 eligible
f_no_device = 1 - d // no billed wearable
Step 2 — Mgmt presence inside each device tier:
// microstructure constants (Chicagoland defaults):
// pMgmtOnNoDevice = 0.80 // "Management-Only Track" capture
// pNoMgmtOnFullDevice = 0.30 // device-only leak rate
f_full_mgmt = d * (1 - 0.30) // 98977 + 98980 (+98981)
f_full_noMgmt = d * 0.30 // 98977 alone
f_noDev_mgmt = (1 - d) * 0.80 // 98980 (+98981) stand-alone
f_inactive = (1 - d) * 0.20
Step 3 — Add-on split inside each mgmt bucket (driven by a + pBrief):
// a = avgAddon slider read as "% of 98980 months that also bill 98981"
// pBrief = 0.42 microstructure default
shareFull = 0.5 * a + 0.5 * (1 - pBrief) // full 98980+98981
shareBrief = 1 - shareFull // 98980 alone
Step 4 — Story assignment (sums to 1.0):
story_2_full_full = f_full_mgmt * shareFull // 98977+98980+98981
story_3_full_brief = f_full_mgmt * shareBrief // 98977+98980
story_4_deviceOnly = f_full_noMgmt // 98977 alone
story_5_noDev_full = f_noDev_mgmt * shareFull // 98980+98981
story_6_noDev_brief = f_noDev_mgmt * shareBrief // 98980 alone
story_7_inactive = f_inactive // $0
story_1_setup = newThisMonth * RATES.c98975 // additive on top
// mgmtPct slider then acts as a cap if the operator reports lower
// mgmt-completion than microstructure implies (linear leak).
The 80% pMgmtOnNoDevice factor anchors to PDF p.30: of MotionPath's 941 mgmt-only billing months, only ~50 were dropped to inactive because of brief or missed calls. The 30% pNoMgmtOnFullDevice factor reflects field observation that ~3 in 10 wearable-compliant patients still miss the 20-min mgmt window in any given month — PT/OT staffing is the binding constraint, not device technology.
CALC-04 Slider-to-Revenue Math
The four sliders map directly to the decomposition above. Sliders are deliberately exposed at the engagement layer rather than per-code, because operators think in terms of "how many of my patients hit 16 device-days", not "how many 98977s did I bill".
Per patient-month expected revenue (RTM-MSK):
E[$/pt-mo] = f_story_2 * $135 // 98977+98980+98981
+ f_story_3 * $94 // 98977+98980
+ f_story_4 * $40 // 98977 alone
+ f_story_5 * $95 // 98980+98981 (mgmt-only)
+ f_story_6 * $54 // 98980 alone (mgmt-only)
+ f_story_7 * $0 // inactive
Monthly org revenue:
$org = enrolled[t] * E[$/pt-mo] + new[t] * $20 // 98975 setup
Enrollment growth (slider g, monthly):
enrolled[t+1] = enrolled[t] * (1 + g/100)
new[t+1] = enrolled[t+1] - enrolled[t] + churned[t]
churned[t] = enrolled[t] * 0.05 // 5%/mo RTM-MSK average (episodic post-op programs)
The 5%/mo churn assumption reflects RTM-MSK's episodic nature — most post-op programs run 8–12 weeks then graduate, so panels turn over twice as fast as chronic-condition RPM. The Chicagoland benchmark used here is MotionPath's observed device-capture (~45%) and mgmt-completion (~75%) at the May 2026 actuals; best-in-class operators target 75% / 88% within a year of launch with structured PT/OT workflow design (Tenovi 2026 RTM codes).
CALC-05 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.
addon_revenue_per_pt_mo = mgmt_share * avgAddon * RATES.c98981
// mgmt_share = fraction of pt-mo billing 98980 (both device and no-device branches)
// avgAddon = share of 98980 months that ALSO bill 98981
// Chicagoland baseline: 0.45 (matches PDF observed 582/(582+359) = 0.62 mix×0.72 mgmt-share)
// Best-in-class: 0.85 (disciplined PT/OT documentation)
addon_org_revenue = enrolled * mgmt_share * avgAddon * $41
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.
CALC-06 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.
// Device tier — pick ONE per patient-month:
IF days >= 16: bill 98977 ($40) // MSK
ELSE IF days >= 2: bill 98985 ($36) // partial credit, NEW 2026
ELSE: no device bill ($0) // → still bill mgmt-only
// Mgmt tier — pick ONE per patient-month:
IF minutes >= 20 AND live: bill 98980 ($54) + N * 98981 ($41 each)
ELSE IF minutes >= 10: bill 98979 ($26) // brief, NEW 2026 stand-alone
ELSE: no mgmt bill ($0)
// 98979 CANNOT be combined with 98981 add-on (98981 attaches only to 98980)
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.
CALC-07 Preset Modes — Chicagoland Standard vs Best-in-Class
Chicagoland Standard preset (MotionPath actuals, anchors to $99/pt-mo):
device_code_capture = 45% // 98977 capture rate per Chicagoland 2025 data
mgmt_completion = 75% // 98980 capture rate per Chicagoland 2025 data
avg_addon = 45% // % of 98980 months also billing 98981
net_growth = 6% // mid-size PT/OT panel
Best-in-class preset (top-decile Chicagoland cohort):
device_code_capture = 75% // top-decile published targets
mgmt_completion = 88%
avg_addon = 85% // disciplined PT/OT documentation
net_growth = 6% // same growth rate
delta_revenue_psm = E[$/pt-mo | best] - E[$/pt-mo | standard]
The presets exist to quickly demonstrate the operational lift available without changing TAM. For MotionPath, the Chicagoland-standard→best-in-class delta is roughly +$32/pt/mo, or ~$20K/month at the current panel (computed live from sliders). That's the management-discipline thesis in one number — and unlike RPM, RTM lift comes mostly from mgmt-side gains, not device-side compliance.
CALC-08 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.