Maximizing Reimbursement: A Guide to Billing Codes & Compliance for RTM and Medication Adherence Tools

If you’ve ever felt that billing for digital health services is like decoding a secret language, you’re not alone. Between tracking patient data, ensuring documentation accuracy, and staying compliant with CMS updates, healthcare providers today are juggling more than ever. But here’s the truth: when done right, Remote Therapeutic Monitoring (RTM) can do more than just improve patient adherence—it can also create new and sustainable revenue streams.

At Smart Pillbox, our mission is simple: to improve medication adherence and support RTM programs that help patients stay on track while empowering providers with real-time insights. In this guide, we’ll walk you through how RTM reimbursement works, what documentation matters most, and how you can confidently bill for your adherence and monitoring programs while staying 100% compliant.

Understanding the RTM Landscape

Let’s start with the basics. Remote Therapeutic Monitoring is not just another buzzword—it’s a critical part of modern care delivery. It’s designed to help clinicians monitor non-physiological data, such as medication adherence, therapy progress, or respiratory function.

While Remote Patient Monitoring (RPM) focuses on physiological metrics like blood pressure or glucose levels, RTM vs RPM billing differs in one crucial way—RTM allows non-physician providers like physical therapists or behavioral health clinicians to participate and get reimbursed for remote care.

According to the Centers for Medicare and Medicaid Services , RTM billing enables healthcare providers to capture reimbursement for time spent reviewing data, communicating with patients, and adjusting care plans remotely. This means that when your patients use digital adherence tools like Smart Pillbox, the time you spend analyzing that data can be billed directly under CMS reimbursement for RTM codes.

The Codes That Make It Possible

Here’s where things get interesting. CMS introduced specific RTM billing codes in 2022 to support remote therapeutic interventions. Let’s break them down in plain language:

1. CPT Code 98975 — Device Setup and Patient Education Billing
   This covers the initial setup and education time when onboarding a patient onto your RTM platform or device. Think of it as your “welcome session” where you explain how to use Smart Pillbox, set up reminders, and document consent.
2. CPT Codes 98976 and 98977 — Remote Adherence Monitoring Reimbursement
   These codes cover the ongoing collection and transmission of data from therapeutic devices like Smart Pillbox. Whether the patient is taking medication for hypertension, COPD, or pain management, these codes ensure that the remote tracking time is billable.
3. CPT Code 98980 — Clinical Time Reimbursement Codes for RTM
   This code covers 20 minutes of treatment management by a qualified healthcare professional each month. It includes reviewing patient adherence data, communicating with the patient or caregiver, and making necessary care adjustments.
4. CPT Code 98981 — Additional 20 Minutes
   If you spend more than the initial 20 minutes reviewing data or interacting with the patient, you can bill for each additional 20-minute block using this code.

When combined strategically, these therapy monitoring compliance codes can help providers maximize reimbursement while maintaining focus on patient care.

Documentation Is the Backbone of Reimbursement

While the billing codes open the door, documentation standards for RTM billing determine whether you actually get paid. CMS and commercial payers require detailed records that validate each billed service.

Here’s what a strong documentation framework should include:

• Patient consent for remote monitoring.

• Device setup details (who, when, and how it was done).

• Therapeutic data collected (for instance, medication adherence logs from Smart Pillbox).

• Clinical decisions or interventions made based on that data.

• Time logs showing minutes spent analyzing data or communicating with patients.

Providers must also follow billing guidelines for RTM services to avoid claim denials. Remember, incomplete or vague documentation is one of the most common reasons claims are rejected.

At Smart Pillbox, we simplify this process by automatically recording adherence data, generating reports, and securely storing timestamps—so that your documentation always matches CMS expectations.

Why Compliance Matters More Than Ever

Compliance is the safety net that keeps your reimbursement efforts running smoothly. When billing for digital health tools, compliance for digital adherence tools means adhering to HIPAA regulations, CMS coverage criteria, and DEA standards (in cases involving controlled substances).

Providers are encouraged to align with therapy monitoring compliance codes to ensure their billing is legitimate and their patient data is protected.
Beyond protecting against audits, good compliance practices build trust—with patients, payers, and regulatory bodies.

Maximizing Reimbursement: The Strategic Approach

Let’s talk about strategy. The goal is not just to bill for RTM—it’s to optimize your RTM program for sustainable reimbursement. Here are five steps to get there:

1. Identify Eligible Patients
   Start with patients managing chronic conditions like diabetes, hypertension, or COPD who could benefit from digital medication adherence support.
2. Use Validated Devices
   CMS reimbursement for RTM applies only to devices that meet FDA standards and can collect and transmit therapeutic data automatically. Smart Pillbox, for example, records medication adherence events in real time, making it fully compliant.
3. Set Up Efficient Workflows
   Your clinical staff should have a defined process for onboarding patients, reviewing data, and logging time. Automating repetitive tasks ensures that you stay compliant without wasting valuable minutes.
4. Leverage Team-Based Billing
   RTM vs RPM billing rules allow multiple providers to participate. For example, a nurse or physical therapist can provide data review under supervision, giving your practice more flexibility.
5. Track and Optimize Outcomes
   The ultimate purpose of these billing codes is not just to generate revenue but to demonstrate measurable improvement in adherence and outcomes. Regularly assess which patients benefit most from monitoring, and fine-tune your programs accordingly.

Medication Adherence and Financial Performance Go Hand-in-Hand

It’s no secret that poor adherence drives higher costs and lower outcomes. According to the World Health Organization, nearly 50% of patients with chronic diseases fail to take their medication as prescribed, costing the U.S. healthcare system over $300 billion each year in avoidable hospitalizations and complications.

That’s where medication adherence reimbursement becomes both a clinical and financial strategy. By using remote monitoring tools like Smart Pillbox, providers not only improve patient adherence but also create new billing opportunities under remote adherence monitoring reimbursement frameworks.

This alignment between patient engagement and financial sustainability is what makes RTM one of the most exciting frontiers in healthcare innovation.

Common Pitfalls to Avoid in RTM Billing

Even experienced providers can make mistakes when it comes to remote therapeutic monitoring billing requirements. Here are a few to watch for:

• Under-documenting clinical time: Always log your minutes precisely; CMS audits depend heavily on time tracking.

• Billing without sufficient patient interaction: RTM codes require documented communication with the patient or caregiver.

• Skipping follow-up documentation: Every intervention or insight must link back to the patient record.

• Using non-qualified devices: Only validated, connected devices like Smart Pillbox qualify for billing.
    

Avoiding these errors can mean the difference between seamless reimbursement and denied claims.

How Smart Pillbox Fits In

Smart Pillbox was built for this exact ecosystem. It automates adherence tracking, creates real-time logs, and integrates with RTM billing workflows seamlessly. For providers, it’s a turnkey solution that:

• Tracks medication intake automatically.

• Generates reports that meet CMS documentation standards.

• Supports billing for adherence tracking solutions without additional manual effort.

• Simplifies compliance for digital adherence tools with secure, HIPAA-compliant data storage.

Whether you’re a small practice or part of a large health system, Smart Pillbox turns RTM billing from a confusing maze into a clear, actionable process.

The Bigger Picture: Technology and Reimbursement Converge

The healthcare industry is at a turning point. Payers are rewarding technology-enabled adherence programs, CMS is offering generous reimbursement for RTM services, and patients are more digitally connected than ever.

For providers, this is the moment to bridge technology with reimbursement—improving outcomes while driving growth.

Conclusion: Turning RTM Into Opportunity

In the end, billing is not just about numbers—it’s about impact. Every time a patient takes their medication on time, every time a clinician receives an alert through Smart Pillbox, and every time an RTM claim is approved, the healthcare system moves one step closer to smarter, more connected care.

If you’re ready to strengthen your RTM billing program and turn medication adherence into measurable revenue, schedule a call with our experts today.

Let’s make compliance simple, reimbursement reliable, and healthcare smarter—together.