Driving new revenue streams with RTM and home exercise programs
At a glance
- RTM and HEP create billable activity between visits. RTM reimburses monitoring time, while HEP increases visit completion and protects existing revenue.
- HEP data enables RTM billing and better clinical decisions. Client-reported adherence and symptom data provide the documentation required for monitoring workflows.
- Adherence directly affects revenue outcomes. Low HEP completion increases cancellations and early discharge, reducing the total number of billed visits per plan of care.
- RTM billing depends on clear thresholds and documentation. Most codes require at least 16 days of patient data and 20 minutes of documented clinical review time per period
Table Of contents
Most rehab therapy practices generate revenue only when clients are physically in the clinic. Visits are delivered, units are billed, and revenue stops the moment the client leaves.
What’s often missed are the revenue opportunities that exist between visits; the time when clients are (or should be) exercising, reporting progress, and staying engaged in their plan of care.
Remote Therapeutic Monitoring (RTM) and structured Home Exercise Programs (HEP) create new ways to capture clinical value during that in‑between time.
RTM is a billing category with its own CPT codes, reimbursed for clinical monitoring time outside the clinic. HEP is an engagement strategy that improves the adherence data that feeds RTM. When used together, they extend care beyond the treatment room, improve adherence, and unlock billable monitoring revenue without adding in‑clinic visits.
“Understanding RTM and how billing for RTM can help increase revenue is one of the most underestimated opportunities in rehab therapy right now.”
— Shannon Foster, MS OTR/L | Senior Account Executive, Fusion by Ensora Health
The HEP revenue case: adherence is a billing problem
Home exercise program adherence rates in outpatient rehab are notoriously low. Published estimates suggest that between 35% and 65% of clients fail to complete their prescribed home programs, depending on condition and population.
That matters financially because non-adherent clients are more likely to plateau, miss visits, or drop off care early. A client approved for 18 visits who exits at 9 because they weren’t progressing is revenue that didn’t materialize. It’s also a plan-of-care outcome that affects your re-authorization track record with payers.
Research summarized by Physiopedia, found that structured digital home program monitoring significantly improved HEP adherence compared to paper-based alternatives. Practices that give clients a clear, accessible way to follow their programs and report back see better completion rates, and better completion rates mean more visits fully utilized per authorization.
HEP is not a new concept. What’s new is the infrastructure to deliver it in a way that generates between-visit data, and that data is exactly what RTM billing requires.
The RTM revenue case: billing for between-visit time
RTM is a Medicare billing category introduced in 2022. It’s separate from remote patient monitoring (RPM), which tracks physiological data like heart rate and blood pressure. RTM is specifically for therapy. It reimburses clinical staff for monitoring how clients are doing between sessions, using data they self-report through an app.
PT, OT, and SLP are all eligible to bill RTM under Medicare. Here are the five codes. This table is a useful reference for billing staff, but the two numbers that actually drive eligibility are summarized below it.
| Code | What it covers | What you need to bill it |
|---|---|---|
| 98975 | Initial setup and education, billed once per episode of care | One-time per client; covers onboarding them to the monitoring app |
| 98976 | Monthly supply code, respiratory system monitoring | Requires 16 days of data in a 30-day period |
| 98977 | Monthly supply code, musculoskeletal monitoring | Requires 16 days of data in a 30-day period |
| 98980 | Treatment management, first 20 minutes of clinical review | Requires documented staff time reviewing and acting on data |
| 98981 | Treatment management, each additional 20 minutes | Billable in additional 20-minute increments beyond 98980 |
Two numbers that drive all of RTM billing:
16 days — the minimum number of days with client data within a 30-day period to bill the supply codes (98976 or 98977).
20 minutes — the minimum documented clinical staff time per billing period to bill the treatment management code (98980).
If both are met and documented, RTM billing is supportable. If either is missing, it generally is not.
NOTE: Under the 2026 Medicare Physician Fee Schedule final rule, CMS finalized additional RTM CPT codes that allow billing for shorter monitoring periods and reduced clinical time thresholds.
New RTM codes (including 98985 for 2–15 days of musculoskeletal monitoring and 98979 for 10–19 minutes of treatment management time) supplement — rather than replace — the original RTM codes.
The original 16‑day data and 20‑minute time thresholds still apply when billing 98976, 98977, 98980, and 98981. Practices must select codes based on actual monitoring duration and documented time.
How HEP and RTM work together in practice
Here’s what the combined workflow looks like for a client on a post-surgical shoulder protocol, for example:
- Day 1: Therapist assigns a home exercise program through their HEP software or integration. The client receives the program on their device with exercises, video, sets, reps, and progression cues.
- Ongoing: Client logs exercise completion and reports pain levels in the app. That data is transmitted to the therapist’s monitoring dashboard.
- 16-day mark: Practice has met the data threshold to support RTM supply code billing (98976).
- Monthly: Clinical staff reviews the monitoring data, notes patterns, and communicates with the client as needed. That review time is logged and supports 98980 billing.
- Next in-clinic visit: Therapist arrives with two weeks of between-session data. The session is clinically richer, and the documentation already reflects the client’s actual between-visit experience.
Fusion’s EHR is now integrated with Wibbi’s leading HEP software. Therapists can assign programs and track client data without switching platforms. And coming very soon, this integration will also support RTM billing documentation.
A simple framework for estimating your RTM revenue potential
You don’t need a complex model to understand whether RTM is worth implementing. Run through these for your own practice:
- How many active clients have a meaningful home program component? This is your RTM-eligible caseload.
- Of those, how many do you see two or more times per week for at least six weeks? These are the clients most likely to generate the 16-day data threshold consistently.
- What is your average Medicare or commercial payer mix? RTM reimbursement rates vary by payer. Confirm current Medicare rates and verify commercial payer coverage separately before assuming universal billing eligibility.
- What is the administrative overhead to document monitoring time? This is the real variable. Practices with a clear workflow for logging the 20-minute monitoring time bill 98980 consistently. Those without one often can’t support the code.
A practice with 30 eligible clients running RTM consistently can generate meaningful supplemental revenue from codes that don’t require additional in-clinic visits. The billing efficiency depends almost entirely on how well the monitoring workflow is documented.
HEP is live. RTM is coming.
Fusion now provides a built‑in way to deliver and manage digital home exercise programs through its integration with Wibbi.
Powered by Wibbi’s library of 20,000+ evidence‑based exercises and 300+ templates, the integration delivers structured programs through a dedicated client mobile app with guided instructions, reminders, and adherence tracking; creating visibility into what’s happening between visits.
This same infrastructure is what enables remote therapeutic monitoring. RTM capabilities within Fusion are coming very soon, building on the adherence and client‑reported data already captured through Wibbi.
Ready to see how it works? Request a demo and ask to see the HEP and RTM workflow.
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