Does Medicare Cover RTM? Medicare Advantage & Commercial, Explained

Q: Does Medicare cover RTM in 2026?

Yes. Traditional (fee-for-service) Medicare covers Remote Therapeutic Monitoring nationally as a Medicare Part B benefit, under CPT codes 98975 (setup), 98977/98985 (device supply), and 98979/98980/98981 (treatment management), effective under the CY2026 Medicare Physician Fee Schedule final rule.

Q: Do Medicare Advantage plans cover RTM the same way as traditional Medicare?

Medicare Advantage organizations are required to cover the same Part A and Part B benefits as traditional Medicare, so RTM is a covered benefit under MA. In practice, plans commonly differ in two ways traditional Medicare does not: many require prior authorization for RTM, and contracted payment rates are plan-negotiated rather than the national fee schedule amount. Confirm both, in writing, with the specific plan before enrolling a patient.

Q: Does my commercial insurance cover RTM?

It depends on the payer. Many commercial payers structurally follow Medicare's RTM code set, but coverage isn't guaranteed the way it is under traditional Medicare — some payers don't cover RTM at all, and adoption of the codes added for CY2026 (98985 and 98979) is inconsistent. Pull the payer's specific RTM medical policy before enrolling a commercially insured patient.

Q: Does Medicaid cover RTM?

It depends entirely on the state. There is no federal RTM Medicaid mandate the way there is for Medicare Part B — coverage is set state by state through each state's fee schedule and provider bulletins, not annual national rulemaking. Several state Medicaid programs don't cover the RTM code family at all, and among states that do, covered codes, thresholds, and provider-type eligibility vary.

Q: What should a practice check before billing RTM to a non-Medicare payer?

Before enrolling a Medicare Advantage, commercial, or Medicaid patient in RTM: pull that payer's specific RTM medical policy rather than assuming Medicare parity, confirm whether the CY2026 codes (98985, 98979) are adopted, check for prior authorization, confirm which provider types the payer allows to bill RTM, and get the contracted or state fee-schedule rate in writing instead of assuming the Medicare rate applies.

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The short answer Traditional Medicare Medicare Advantage Commercial insurance Medicaid Coverage at a glance Before you enroll a non-Medicare patient FAQ

Key takeaways

Traditional Medicare covers RTM nationally under CPT 98975–98981 — the one payer where you don't have to check first.
Medicare Advantage must offer the same benefit by law, but plans commonly add prior authorization and pay plan-contracted rates, not the national fee schedule.
Commercial coverage isn't guaranteed — some payers don't cover RTM, and adoption of the two codes added for CY2026 is inconsistent.
Medicaid is state-by-state, with no federal RTM mandate — several states don't cover it at all.

Yes — traditional Medicare covers Remote Therapeutic Monitoring nationally, as a nationwide Medicare Part B benefit under CPT codes 98975–98981. Medicare Advantage plans are required to cover that same benefit, though many layer on plan-level rules traditional Medicare doesn't have, starting with prior authorization. Commercial insurance and Medicaid are the two you can't assume: coverage varies payer by payer and state by state, and isn't guaranteed at all.

As of the CY2026 Medicare Physician Fee Schedule (final rule CMS-1832-F, effective January 1, 2026). General educational information, not billing or legal advice. Coverage, prior-authorization, and payment specifics vary by payer, plan, and locality — confirm with your biller and the payer directly before billing.

Traditional Medicare: yes, and nationally consistent

Fee-for-service (traditional) Medicare covers RTM as a Part B benefit across the whole code family: 98975 for initial setup, 98977/98985 for device supply (split by data-days collected in a 30-day period), and 98979/98980/98981 for treatment management time, each requiring a documented interactive call. This is the one payer relationship where an MSK practice doesn't have to check whether RTM is covered at all — it's a nationally recognized benefit, not a plan-by-plan or state-by-state judgment call. For the full code-by-code breakdown, thresholds, and what changed for 2026, see the 2026 RTM CPT codes guide; for the dollar amounts, see the RTM revenue math — this article deliberately doesn't restate payment figures (more on why in Sources & verification, below).

Medicare Advantage: the same benefit, on the plan's terms

Medicare Advantage organizations are required to cover all the Part A and Part B services that traditional Medicare covers for beneficiaries in their service area — that's the basic-benefits parity rule that underlies the MA program. RTM, as a covered Part B benefit, carries over. That's the good news: an MA patient isn't automatically excluded from RTM.

What doesn't carry over automatically is how the plan administers it. Two differences show up often enough to plan around:

Prior authorization. Traditional Medicare doesn't require prior auth for RTM. Many MA plans do — as a plan-level utilization-management decision, not a national rule.
Contracted rates. MA plans negotiate their own rates rather than paying the national Physician Fee Schedule amount, so per-code payment can differ from what traditional Medicare pays for the same service.

A Medicare Advantage patient is eligible for RTM by law. Whether that first claim gets paid without a fight depends on the plan, not the statute.

The practical move: before enrolling an MA patient in an RTM program, confirm the specific plan's prior-authorization requirement and contracted rate in writing, rather than assuming it mirrors traditional Medicare.

Commercial insurance: coverage isn't guaranteed

Commercial payers are the least predictable tier. Many structurally follow Medicare's RTM code set — same six codes, similar thresholds — because it's the established billing framework. But coverage itself isn't guaranteed the way it is under traditional Medicare: some commercial payers don't cover RTM at all, and adoption of the two codes added for CY2026 (98985, the 2–15 data-day device-supply code, and 98979, the 10–19 minute management tier) is inconsistent — a payer's claims system may simply not have loaded them yet.

Prior authorization, unit caps on the add-on management code (98981), and which provider types the payer allows to bill RTM also vary by contract. None of that is safe to assume from the Medicare baseline — it has to come from that payer's specific RTM medical policy.

Medicaid: it depends entirely on the state

There's no federal RTM Medicaid mandate the way there is for Medicare Part B. Medicaid RTM coverage is decided state by state, through each state's own fee schedule and provider bulletins — not through annual national rulemaking the way the Medicare Physician Fee Schedule works. The result is wide variance: several state Medicaid programs don't cover the RTM code family at all (some cover the RPM — Remote Physiologic Monitoring — codes instead, or neither), and among states that do cover RTM, which codes are payable, the thresholds used, and which provider types can enroll to bill it all differ. Managed-Medicaid (MCO) plans within a state can diverge further from that state's own fee-for-service policy.

If a patient is on Medicaid, treat coverage as an open question to confirm with that state's current fee schedule and provider manual — never as a Medicare-parity assumption.

Coverage at a glance

Payer	Covers RTM?	Biggest difference from traditional Medicare	Confirm before enrolling
Traditional Medicare (Part B)	Yes, nationally	None — this is the baseline	Standard requirements: consent, data-days, management time, the call
Medicare Advantage	Yes, by parity requirement	Plan-level prior authorization is common; rates are plan-contracted	The specific plan's prior-auth policy and contracted rate, in writing
Commercial	Varies by payer	Some payers don't cover RTM at all; new CY2026 codes not universally adopted	That payer's RTM medical policy and fee schedule
Medicaid	Varies by state	No federal mandate; several states don't cover RTM at all	Current state Medicaid fee schedule and provider bulletin

Coverage status shown at a category level. Individual plans, payers, and states diverge — this table is a starting point for verification, not a substitute for it.

Before you enroll a non-Medicare patient in RTM

Pull the payer's specific RTM medical policy — don't assume Medicare parity just because the code set looks the same.
Confirm whether the CY2026 codes are adopted — 98985 and 98979 are new; some payers haven't loaded them yet.
Check for prior authorization — common on Medicare Advantage plans, and possible on commercial and Medicaid plans, even though traditional Medicare doesn't require it.
Confirm which provider types the payer allows to bill RTM — some plans and states restrict RTM to physicians/NPPs and don't enroll PTs or OTs the way traditional Medicare does.
Get the rate in writing — plan-contracted, commercial-contracted, and state fee-schedule amounts can all differ from the national Medicare rate; don't assume it carries over.

The coverage question comes before the billing question.

BoneArc tracks data-days, review time, and call attestations the same way regardless of payer — so once coverage is confirmed, the documentation is already there.

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FAQ

Does Medicare cover RTM in 2026?

Yes. Traditional Medicare covers RTM nationally as a Part B benefit under CPT 98975–98981, effective under the CY2026 Medicare Physician Fee Schedule final rule.

Do Medicare Advantage plans cover RTM the same way as traditional Medicare?

MA organizations must cover the same Part A/B benefits as traditional Medicare, so RTM is covered. In practice, plans commonly add prior authorization and pay plan-contracted rates rather than the national fee schedule amount — confirm both with the specific plan.

Does my commercial insurance cover RTM?

It depends on the payer. Many follow Medicare's RTM code structure, but coverage isn't guaranteed — some payers don't cover RTM at all, and adoption of the CY2026 codes (98985, 98979) is inconsistent. Check that payer's specific medical policy.

Does Medicaid cover RTM?

It depends entirely on the state. There's no federal RTM Medicaid mandate — coverage, codes, thresholds, and provider-type eligibility are set state by state, and several states don't cover RTM at all.

What should a practice check before billing RTM to a non-Medicare payer?

Pull that payer's specific RTM medical policy, confirm CY2026 code adoption, check for prior authorization, confirm which provider types can bill, and get the contracted or state fee-schedule rate in writing — don't assume Medicare parity.

Sources & verification. Traditional Medicare coverage of the RTM code family (98975, 98977, 98985, 98979, 98980, 98981) reflects the CY2026 Medicare Physician Fee Schedule final rule (CMS-1832-F, RTM discussion 90 FR 49394–49404), consistent with this repository's verified payer-rules/medicare-baseline.json (retrieved and cross-checked 2026-07-03). The Medicare Advantage basic-benefits parity requirement is stated per 42 CFR 422.101; the plan-level prior-authorization and contracted-rate caveats reflect payer-rules/medicare-advantage.json (a deliberately unverified stub pending per-plan confirmation — see that file). Commercial-payer variance and inconsistent CY2026 code adoption reflect payer-rules/commercial-template.json (a template requiring per-contract verification). Medicaid state variance reflects payer-rules/medicaid-VARIANCE-NOTE.md, prepared as part of this repository's RTM billing integrity audit. Verification note: this article's author attempted to re-fetch primary sources directly (govinfo.gov, ecfr.gov, federalregister.gov, cms.gov, law.cornell.edu) on 2026-08-12 per this repository's standing rule requiring external re-verification of regulatory constants; all were blocked by this environment's network egress policy. A web search was used as a partial substitute and corroborated the existence, effective date, and day/minute threshold structure of the CY2026 RTM codes, but also surfaced pre-correction dollar figures (e.g. 98977/98985 at $39.75) that this repository's own audit has already identified as superseded by CMS correction notice FR 2026-04797 — for that reason, this article states no new CPT dollar payment amounts and links instead to the already-verified CPT codes guide and RTM revenue math for those figures. The 42 CFR 422.101 parity citation was corroborated via search-indexed summary only, not a direct primary-source fetch. Recommend a follow-up verification pass from an environment with direct access to govinfo.gov/ecfr.gov/cms.gov before treating the Medicare Advantage and Medicaid characterizations here as independently re-confirmed beyond what's already recorded in this repository's payer-rules files. Educational information, not billing or legal advice — confirm coverage with each payer directly.