Updates for RTM in 2026: Key Changes in the CMS Proposed Rule
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (PFS) for 2026. A key part of the proposal includes important changes to Remote Therapeutic Monitoring (RTM), such as new CPT codes and expanded reimbursement options. These updates could affect how providers deliver care and get paid in the coming year.
Two New MSK RTM Codes Proposed:
Starting January 1, 2026, CMS plans to add two new CPT codes to the musculoskeletal (MSK) RTM code set:
1️⃣ 2–15 days of patient data transmission via MSK RTM devices in a 30-day period (98XX5)
2️⃣ 10–19 minutes of monthly treatment management services for RTM patients (98XX7)
2️⃣ 10–19 minutes of monthly treatment management services for RTM patients (98XX7)
🔮The Future of RTM in 2026
These proposals signal CMS’s willingness to provide long-term support for RTM by expanding reimbursement options and encouraging broader adoption of technology-driven care for patients with musculoskeletal conditions.
Below are the two new MSK RTM codes that are proposed to be covered and paid for beginning January 1, 2026:
| MSK Code | Description | Benefits For Your Practice |
|---|---|---|
| 98XX5 | Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period | Facilitates early detection of therapy issues and supports more personalized treatment adjustments |
| 98XX7 | Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 10 minutes | Enhances continuity of care, enables timely intervention, and supports better clinical outcomes |
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Note: The “X” in the CPT codes listed above is a placeholder. The American Medical Association (AMA) will release the official 5-digit numerical CPT codes for 2026 in September 2025.
Proposed 2026 Conversion Factor Updates:
CMS is also proposing an increase in the Medicare conversion factor, which determines how much providers are paid for each service.
Key Highlights:
- Two Separate Conversion Factors (Required by Statute) – Starting in 2026:
- Qualifying Alternative Payment Model (APM) participants: +0.75%
- Non-qualifying APM physicians/practitioners: +0.25%
- Legislative Adjustment – A one-year increase of +2.5% for 2026.
- Work RVU Adjustment – An estimated +0.55% increase tied to proposed changes in work RVUs for certain services.
Proposed 2026 Conversion Factors:
- Qualifying APM: $33.59 (+3.83% vs. 2025)
- Non-qualifying APM: $33.42 (+3.62% vs. 2025)
Projected Changes in Payments:
| CPT Code | Description | 2025 Avg. Payment | 2026 Payment (non APM-Qualifying) | 2026 Payment (APM-Qualifying) |
|---|---|---|---|---|
| 98975 | Initial set-up & patient education on use of equipment; one time at initial enrollment | $19.73 | $21.72 | $21.83 |
| 98XX5 (proposed) | RTM device to monitor MSK system status, 2-15 days of data in a 30-day period | N/A | $39.77 | $39.97 |
| 98977 | RTM device to monitor MSK system status, 16-30 days of data in a 30-day period | $43.02 | $39.77 | $39.97 |
| 98XX7 (proposed) | 10-19 minutes of RTM treatment management services in a month | N/A | $26.07 | $26.2 |
| 98980 | 20-39 minutes of RTM treatment management services in a month | $50.14 | $53.81 | $54.08 |
| 98981 | Each additional 20 minutes of RTM treatment management services in a month | $39.14 | $41.11 | $41.32 |
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🔍What does this mean for your Practice?
These changes offer new opportunities and greater financial stability for practices using RTM such as:
- New billing opportunities: You can now be reimbursed for shorter device usage periods and less time-intensive care
- Greater flexibility: Reimbursement is possible even when patients don’t meet the full 16-day threshold
- Real-world alignment: Recognizes that not all patients need extensive monthly monitoring
- Support for better outcomes: Supports earlier interventions and personalized treatment
- Increased revenue: Higher conversion factors translate to better reimbursement
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🚀 Why PhyxUp Health Is Ready to Help
PhyxUp Health is built to help providers stay ahead of policy changes. We make it easier to deliver and bill for RTM services, especially for musculoskeletal care.
Why PhyxUp stands out:
- Purpose-Built for RTM in MSK Care: PhyxUp Health was designed specifically to support musculoskeletal care delivery, making it an ideal fit for the newly proposed MSK RTM codes (98XX5 and 98XX7)
- Regulatory Readiness: Our product and clinical operations teams closely monitor CMS updates and AMA CPT releases and adjust our system accordingly
- Scalable Infrastructure: Whether you're a single clinic or a multi-location health system, PhyxUp Health's platform is ready to scale
- Built for Value-Based Care: With the rise of APMs and increasing emphasis on outcomes, PhyxUp Health is not just a compliance tool—it’s a partner in driving better clinical results
- Proven Value: Our partners consistently report improved reimbursement capture and reduced documentation burden—key outcomes in a climate where CMS is increasing incentives for digital monitoring and clinician-patient communication
As CMS paves the way for broader RTM adoption, PhyxUp Health is ready to empower providers to lead the future of value-driven, tech-enabled musculoskeletal care.
