Knee and hip replacement recovery
Adherence and ambulation in the first three weeks tell you who is falling behind.
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.
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.
These are configurable program defaults, not clinical recommendations. The treating clinician sets every threshold for their own panel and owns the response it triggers. Nothing here is medical advice.
How the month actually runs
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 |
CY2026 national non-facility averages, for orientation only. Your locality, payer, and place of service will differ. Coverage, coding, and medical necessity remain the treating practitioner's responsibility.
Diagnosis anchors
| ICD-10-CM | Description |
|---|---|
| Z96.651 | Presence of right artificial knee joint |
| Z96.641 | Presence of right artificial hip joint |
| M17.11 | Unilateral primary osteoarthritis, right knee |
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.
If you are a manufacturer looking at this condition
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.
Knee and hip replacement recovery monitoring, answered directly
Can we bill RTM during a global surgical period?
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.