RTM program · Physical therapy

Chronic low back pain

The prescribed exercises work. Roughly half of patients do them.

Musculoskeletal RTM is the most mature use of the therapeutic monitoring codes and the one payers understand best. The clinical premise is unglamorous: home exercise programs have decent evidence and terrible adherence, and adherence responds to being observed. The measurement that matters is sessions completed, and the intervention that matters is a human noticing within a week rather than at the six-week follow-up.

Chronic low back pain · 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.

Exercise adherence

App-logged sessions with movement verification where available

Sessions completed against sessions prescribed, plus completion quality. Self-report alone drifts optimistic by a wide margin.

Range of motion

Camera-based flexion, extension, lateral bend

Objective and repeatable enough to show a trajectory, which is what a payer and a patient both want.

Pain and function

Numeric rating plus Oswestry short form, twice weekly

Function moves before pain does. Programs that only track pain look like failures for the first three weeks.

Activity

Passive step and sedentary time

Total activity is the best proxy for whether the program changed anything about the patient's life.

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.

Adherence below 50% for 7 days

ResponseRe-engagement contact, program simplification

Pain rise of 3 points with adherence intact

ResponseClinical review, program modification

New radicular symptoms or any red flag item

ResponseSame-day clinical review

Function flat for 21 days with adherence above 80%

ResponseThe program is wrong, not the patient

Program operation

How the month actually runs

Program prescribed with a specific weekly session target. No target means no adherence measure.

Setup and education billed once under 98975.

Daily logging with camera-based range of motion weekly.

Adherence drop triggers simplification before it triggers a lecture. Simplification works better.

Day 30: transmitted-day counter selects 98977 or 98985. Management time billed 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
98977	Device supply, musculoskeletal, 16-30 days Device supply for musculoskeletal system monitoring, 16 or more days of data in 30.	$39.75	per 30 days
98985new 2026	Device supply, musculoskeletal, 2-15 days New for 2026. Short-duration musculoskeletal device supply. Mutually exclusive with 98977.	$39.75	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
M54.50	Low back pain, unspecified
M54.51	Vertebrogenic low back pain
M51.36	Other intervertebral disc degeneration, lumbar region

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

Mostly not a pharmaceutical program, and pretending otherwise would waste your time. The sponsored interest here is from device and non-opioid analgesic programs that need functional endpoints, and from employers and workers-compensation payers who care about return-to-work timing more than about pain scores.

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

Chronic low back pain monitoring, answered directly

Does self-reported exercise count for RTM?

Self-reported therapy adherence data can support RTM, which is the central difference from RPM. The device-supply code still requires a medical device supplying data access or transmission, so the software providing that access has to qualify.

How many days of data does musculoskeletal RTM need in 2026?

Sixteen or more days bills 98977. Two to fifteen days bills 98985, new for 2026. One or the other, not both.

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.

Knee and hip replacement recoveryTwo weeks of flexion data tells you which patients are heading for a manipulation. RTM Orthopedic surgery, physical therapy 98975 98977 98985 Rotator cuff and shoulder rehabilitationA long protocol, a bored patient, and a stiffness window that closes quietly. RTM Orthopedic surgery, physical therapy, sports medicine 98975 98977 98985 Concussion and mild traumatic brain injuryRecovery is a trajectory across several independent systems, and none of them is a single score. RTM Neurology, sports medicine, concussion clinic, physical medicine 98975 98978 98986

Start this program All 18 conditions