RTM program · Pulmonology

Asthma

Most uncontrolled asthma is under-treated adherence, not refractory disease.

Asthma is the clearest example of why the RTM family exists. The billable, clinically decisive signal is not a vital sign, it is whether the medicine went into the lungs. Adherence-first monitoring reorders the treatment algorithm: before you escalate a patient to a biologic that costs tens of thousands a year, you find out whether they took the inhaler. A meaningful share of the time they did not.

Asthma · observed transmission profile Representative, not best case

Day 1Day 15Day 30

Transmitted days 0 / 30

Device supply code —

Start this program Model the economics

Signal stack

What gets measured, from where, and why it earns its place

Every source is tagged at ingest as billable or context-only. Context-only data is clinically valuable and never enters a device-supply line.

Controller adherence

Inhaler sensor or structured self-report

The single most valuable number in asthma care and the one nobody has. Sensor data beats self-report by a wide and well-documented margin.

Rescue inhaler use

Same sensor

The control marker. Rising rescue use precedes exacerbation reliably enough to act on.

Peak expiratory flow

Connected peak flow meter, when indicated

Useful in patients who can perform it consistently, which is fewer than you would hope.

Symptom control

Weekly ACT-derived short form

The validated outcome instrument. Pairs with adherence to separate under-treatment from refractory disease, which is the whole clinical question.

Inhaler technique

Periodic video review

A large fraction of apparent treatment failure is technique. Ten minutes of video fixes more than a step-up does.

Escalation design

Thresholds, and who has to do something about them

Red marks a same-day or immediate pathway. Amber marks a review within the stated window. Each one is assigned to a named clinician with a response clock, not to a queue.

Rescue use above 2 days per week

ResponseControl review, step-up assessment

Controller adherence below 50% with poor control

ResponseAdherence intervention before escalating therapy

Rescue use tripled over baseline

ResponseSame-day exacerbation review

Symptom score worsening with adherence above 80%

ResponseGenuine step-up or biologic candidate

Program operation

How the month actually runs

Enroll patients with poor control or before a step-up decision, which is where the value concentrates.

Inhaler sensor plus weekly control score. Peak flow only for patients who can perform it.

Adherence and rescue-use trends reviewed together. Neither means much alone.

Step-up decisions gated on documented adherence, which is also the strongest prior-authorization packet you will ever assemble.

Day 30: 98976 or 98984 by transmitted days. Management time by actual minutes.

Code path · CY2026

What this program can bill

Rates are national non-facility averages, rounded, for orientation. They vary by locality and payer. Verify against your fee schedule before you model revenue on them.

Code	What it covers	National avg	Cadence
98975	Setup and patient education One-time setup and education on use of the monitoring equipment.	$21.71	once per episode
98976	Device supply, respiratory, 16-30 days Device supply for respiratory system monitoring, 16 or more days of data in 30. Practice-expense-only; CMS cross-walked pricing to 99454.	$52	per 30 days
98984new 2026	Device supply, respiratory, 2-15 days New for 2026. Short-duration respiratory device supply. Mutually exclusive with 98976.	$52	per 30 days
98980	Treatment management, first 20 min 20 minutes of QHP management time with at least one interactive communication.	$53.77	per calendar month
98979new 2026	Treatment management, first 10 min New for 2026. 10 to 19 minutes of management time with at least one interactive communication. Mutually exclusive with 98980.	$26.05	per calendar month
98981	Treatment management, each additional 20 min Add-on to 98980. Reported per additional 20 minutes in the month.	$41.8	per additional 20 min

Diagnosis anchors

ICD-10-CM	Description
J45.40	Moderate persistent asthma, uncomplicated
J45.50	Severe persistent asthma, uncomplicated
J45.901	Unspecified asthma with (acute) exacerbation

Illustrative anchors only. Code to the documented clinical picture, not to a list on a vendor website.

The rules that break programs

One billing clinician per 30-day episode. RPM and RTM are not additive in the same calendar month. Duration codes are mutually exclusive. Management time requires at least one real-time interactive communication. Medical necessity precedes enrollment.

Full rule set and calculator

Sponsor view

If you are a manufacturer looking at this condition

One of the strongest sponsored cases in the catalog. Biologic manufacturers need to demonstrate that candidates are genuinely refractory rather than non-adherent, and payers increasingly demand exactly that evidence before authorization. A program yields verified adherence pre-biologic, response trajectories on therapy, and structured discontinuation reasons. This is as close to a clean value alignment as this field offers, and it still needs the same structural care as every other sponsored arrangement.

Read this before you fund anything

Sponsor-funded monitoring that produces billable revenue for prescribers is remuneration to referral sources under the federal Anti-Kickback Statute. The structures that survive scrutiny keep the sponsor's data interest and the provider's billing interest completely separate. The three structures we will build, and the one we will not.

Questions

Asthma monitoring, answered directly

Do inhaler sensors support RTM device-supply codes?

Where the sensor is a medical device supplying data access or transmission for respiratory monitoring, yes. Check the specific clearance status of the sensor you are deploying.

Does adherence monitoring help prior authorization for biologics?

Documented objective adherence directly addresses the most common denial rationale for severe asthma biologics. Many practices find that the strongest argument for running the program.

Adjacent programs

Conditions that travel with this one

Comorbidity is the norm. One episode, one billing clinician, one device-supply line per 30 days, even when the patient has four diagnoses.

COPDThe exacerbation announces itself about four days early, in symptoms rather than saturation. RPM Pulmonology, primary care 99453 99454 99445 Obstructive sleep apneaAdherence is the entire clinical outcome, and it is decided in the first ninety days. RTM Sleep medicine, pulmonology, ENT 98975 98976 98984

Start this program All 18 conditions