Obstructive sleep apnea
Adherence is the entire clinical outcome, and it is decided in the first ninety days.
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.
What we will not oversell
A PAP device supplied by a DME provider is billed by that provider. If the practice is not supplying the monitoring device, the device-supply code does not belong to the practice. This is the most common structural error in sleep RTM programs.
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 |
| 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 |
|---|---|
| G47.33 | Obstructive sleep apnea (adult) (pediatric) |
| G47.30 | Sleep apnea, unspecified |
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.
Obstructive sleep apnea monitoring, answered directly
Who bills the RTM device supply code for a CPAP patient?
Does the payer's 90-day compliance requirement change the RTM billing?
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.