CPT code guide

CPT 98975 in 2026

Initial set-up and patient education

98975 is the code that starts the RTM workflow. It covers getting the patient set up correctly and making sure they actually understand how to use the monitoring experience from day one.

  • Used at the beginning of the RTM episode, not as a recurring monthly code
  • Separate from device-supply billing and separate from treatment-management time
  • Most valuable when the onboarding is real, specific, and tied to the actual plan of care
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One-time set-up code Patient or caregiver education Sometimes therapy GP, GO, or GN when billed as therapy

What 98975 is really for

98975 exists for the start of the monitoring process. The patient is not just handed access and left alone. The clinic configures the workflow, makes sure the patient or caregiver knows what to do, and creates the conditions for meaningful therapeutic data to be generated after that start date.

That is why 98975 is not just a technical onboarding event. It is the moment the RTM episode becomes operational. If the patient does not understand how the program works, what they are expected to do, and what kind of follow-through is required, the rest of the RTM workflow becomes much weaker.

The strongest 98975 claims are the ones where the clinic can clearly show both parts of the service: set-up and education.

Quick facts

How to think about 98975 in practice

Question
Short answer
What that means operationally
What does it cover
Initial set-up and patient education
The clinic configures the RTM workflow and teaches the patient or caregiver how to use it correctly.
When is it billed
At the start of the RTM episode
Think of 98975 as the onboarding event tied to RTM activation, not as something that repeats every month.
What it does not cover
Not device supply, not monthly management
98985 and 98977 cover device-supply thresholds. 98979, 98980, and 98981 cover treatment-management time when those separate rules are met.
Who can bill it
Qualified clinicians, including therapists when appropriate
When therapists furnish RTM under a therapy plan of care, the therapy modifier framework applies.
Therapy modifier logic
Use GP, GO, or GN when billed as therapy
If a PTA or OTA exceeds the de minimis threshold, CQ or CO may also apply to 98975.
Where it can happen
Office or patient’s home, depending on workflow
The key issue is not the room. The key issue is whether the set-up and education actually occurred and are documented clearly.
What does it cover
AnswerInitial set-up and patient education
MeaningThe clinic configures the RTM workflow and teaches the patient or caregiver how to use it correctly.
When is it billed
AnswerAt the start of the RTM episode
MeaningThink of 98975 as the onboarding event tied to RTM activation, not as something that repeats every month.
What it does not cover
AnswerNot device supply, not monthly management
Meaning98985 and 98977 cover device-supply thresholds. 98979, 98980, and 98981 cover treatment-management time when those separate rules are met.
Who can bill it
AnswerQualified clinicians, including therapists when appropriate
MeaningWhen therapists furnish RTM under a therapy plan of care, the therapy modifier framework applies.
Therapy modifier logic
AnswerUse GP, GO, or GN when billed as therapy
MeaningIf a PTA or OTA exceeds the de minimis threshold, CQ or CO may also apply to 98975.
Where it can happen
AnswerOffice or patient’s home, depending on workflow
MeaningThe key issue is not the room. The key issue is whether the set-up and education actually occurred and are documented clearly.

What needs to happen for 98975 to make sense

The cleanest way to think about 98975 is that the patient leaves the onboarding event knowing exactly how the RTM experience works. They know what they are supposed to do, how often they should do it, and what the workflow looks like when something goes wrong or they need help.

That usually includes setting up the home program or monitoring sequence, confirming the patient can access it, explaining reminders and check-ins, and documenting that education was actually delivered to the right person.

What 98975 does not cover

A lot of confusion comes from treating 98975 like a catch-all start-of-month code. It is not. It does not pay for device-supply thresholds, and it does not pay for the clinician’s monthly treatment-management work after the patient is already enrolled.

  • It does not replace 98985 or 98977 when the patient generates qualifying device-supply activity.
  • It does not replace 98979, 98980, or 98981 when the clinic is doing billable monthly management work.
  • It does not become stronger just because the clinic gave a patient app access without meaningful education.
Documentation

What to document for 98975

Record 1

What was set up

Document the RTM system, program, reminders, prompts, or monitoring workflow that was configured for the patient.

Record 2

Who was educated

Make it clear whether the patient or caregiver received the education, and what they were taught to do on a daily basis.

Record 3

Why it mattered clinically

Tie the onboarding to the actual plan of care so the RTM start is not floating separately from the patient’s treatment goals.

How 98975 fits with the rest of RTM

The easiest mental model is simple. 98975 starts the episode. 98985 and 98977 cover the device-supply side when the patient generates qualifying day-based activity. 98979, 98980, and 98981 cover treatment-management work when the clinician is actively managing the patient between visits and the monthly rules are met.

That sequencing matters. If the onboarding is weak, the day-based and time-based codes become harder to support later because the patient never got a strong start.

Related pages: 98985, 98977, 98979, 98980, and 98981.

Common scenarios

Scenario

New post-op patient

The clinic starts RTM at the beginning of the episode, sets the patient up correctly, and educates them on how to complete the daily workflow. This is the cleanest 98975 use case.

Scenario

HEP first, RTM later

The patient may already have a program, but RTM is not actually live until the clinic enables the monitoring workflow and delivers the education tied to that start.

Scenario

Caregiver-supported use

If a caregiver is the one helping the patient complete the daily workflow, the record should say that the caregiver received the education and understood what to do.

The mistakes clinics make with 98975

The most common mistake is treating access as education. Giving the patient a link or login is not the same as actually teaching them how to use the RTM workflow. The second mistake is documenting the start too vaguely. If the note just says “set up patient,” it leaves too much open to interpretation later.

The third mistake is forgetting that 98975 is part of a broader billing structure now. In 2026, the six-code RTM workflow is more granular, which means the onboarding event should point cleanly into the later device-supply and management paths instead of standing alone as a generic start-up charge.

Make RTM simple for your therapists

Orva helps clinics onboard patients cleanly, keep the rest of the RTM workflow organized, and generate billing-ready documentation across all six musculoskeletal RTM codes.

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