So You Think Remote Monitoring Is Just a Cost?
Bring up "remote monitoring" in orthopedic circles in Taiwan, and most colleagues have the same first reaction: sounds good, but who pays for it?
That's a fair question. Taiwan's National Health Insurance doesn't yet have a standalone billing code for post-surgical remote rehabilitation. If you're tracking a patient's pain score, ROM, and exercise adherence through an app after a TKA today, that work is invisible on the books.
But the picture in the United States just changed structurally. In the final rule for the 2026 CMS Physician Fee Schedule, the billing threshold for Remote Therapeutic Monitoring (RTM)[1] dropped from 16 days to just 2. That's not a minor tweak — it redefines what kind of monitoring is worth paying for.
Even if you practice in Taiwan, this policy signal is worth understanding closely. The direction payment systems move in has always been the single strongest driver of how care models change.
What Actually Changed in 2026
In the past, RTM's device supply code required patients to transmit data on at least 16 of 30 days before you could bill. For most orthopedic practices, that was an unrealistic bar — getting a patient in the early post-op window to use the app consistently for 16 days already counted as a win.
In 2026, CMS added CPT 98985, covering the 2-15 day monitoring window specifically[2]. In practice: as long as a patient transmits structured data on 2 of 30 days, you can bill.
| CPT Code | Description | Payment | Threshold |
|---|---|---|---|
| 98985 | MSK remote therapeutic monitoring device supply (2-15 days/30-day period) | $51.00 | 2-15 days of data |
| 98977 | MSK remote therapeutic monitoring device supply (16-30 days/30-day period) | Existing rate | 16-30 days of data |
| 98979 | RTM treatment management, first 10 minutes | $26.00 | 1+ real-time interaction |
| 98980 | RTM treatment management, additional 20+ minutes | Existing rate | 20+ cumulative minutes |
At the same time, CMS designated RTM codes as "sometimes therapy services"[5], meaning physical therapists, occupational therapists, and speech-language pathologists can now bill these codes directly. That breaks RTM's old restriction to physician-only billing, and lets the whole post-surgical care team get paid fairly for remote monitoring.
The Revenue Math
Let's run the numbers on the most conservative scenario.
A patient recovering from TKA uses the app to report her pain score and exercise completion. Over 30 days she transmits data on just 5 days — well under the old 16-day threshold — and your PT spends 12 minutes reviewing her data and makes one phone call to adjust her home exercise program.
- 98985 (device supply, 2-15 days): $51
- 98979 (treatment management, 10-19 minutes): $26
- Minimum revenue per patient per month: $77
Scale that across your practice:
| Monthly RTM Patients | Monthly Revenue | Annual Revenue |
|---|---|---|
| 50 | $3,850 | $46,200 |
| 100 | $7,700 | $92,400 |
| 200 | $15,400 | $184,800 |
And that's just the 2-15 day floor. If a patient's adherence is good and they transmit 16+ days of data, 98977 + 98980 pay more. This revenue used to be zero — your team may already be doing this work; it just wasn't getting paid.
What Counts as RTM
The core of RTM is "structured, patient-generated data transmitted digitally." CMS doesn't mandate a specific device or app, but the data has to be structured and trackable. Within the MSK category, the following all qualify[3]:
- PROM collection: pain VAS/NRS, functional outcome scores (e.g. KOOS-JR, ASES)
- Exercise adherence tracking: records of prescribed exercise completion
- Wound photo submission: structured, digitally transmitted image records
- ROM measurement data: joint range of motion transmitted via app or wearable device
- Any structured patient-reported data: daily check-ins, symptom questionnaires, and similar
If you're already using a system like iRehab to have patients report pain and exercise completion daily, you likely already have an RTM-billable data stream sitting in your hands — you just haven't converted it into revenue yet.
Billing Rules and Gotchas
RTM billing logic has a few important mutual-exclusivity rules — get them wrong and your claim gets denied[1]:
Rule 1: Device supply codes are mutually exclusive. In the same 30-day billing period, you can bill either 98985 (2-15 days) or 98977 (16-30 days) — never both. Say a patient transmits data on 10 of the first 15 days, then 8 more of the next 15: you bill 98977 only, because the total is 16 days or more. You can't split that into two separate codes.
Rule 2: Treatment management codes are mutually exclusive. 98979 (10-19 minutes) and 98980 (20+ minutes) work the same way — pick one. Time is cumulative: if you spend a total of 25 minutes over 30 days on this patient's RTM data management and interaction, bill 98980.
Rule 3: One set per 30 days. Each patient gets, at most, one device supply code plus one treatment management code per 30-day billing cycle.
Rule 4: Real-time interaction is required. The treatment management codes (98979/98980) require at least one real-time interaction with the patient. That can be a phone call, a video visit, or a synchronous in-app message exchange. Passively looking at a data dashboard doesn't count.
The Bigger Picture: Why Now
The drop in the RTM billing threshold isn't an isolated event. It's happening at the intersection of three converging trends.
First, pressure from the TEAM model. 741 U.S. hospitals must now manage the cost of joint-replacement care under a 30-day bundled payment model. Within that framework, practices that can effectively monitor post-surgical patients and catch complications early can cut costs and share in the savings. RTM reimbursement is an additional layer of revenue on top of that.
Second, outpatient surgery is accelerating. Same-day discharge rates for TKA in the U.S. are projected to reach 51-60% by 2026[6]. Patients leaving the hospital sooner means a bigger monitoring gap. RTM isn't just a revenue opportunity — it's infrastructure for clinical risk management.
Third, the evidence base has matured. Research presented at AAOS 2026 on 1,699 TKA patients found RTM to be safe, cost-effective, and equally effective in geriatric populations[4]. A broader systematic review covering 25 RCTs and 4,402 patients concluded that telerehabilitation's clinical outcomes are at least non-inferior to — and in most settings superior to — traditional in-person therapy.
The View from Taiwan
Taiwan's National Health Insurance doesn't have a standalone billing code equivalent to RTM yet. Remote rehab guidance is typically absorbed into the outpatient rehab billing framework, with no additional reimbursement.
But the policy direction is worth watching. The Ministry of Health and Welfare has kept loosening telemedicine regulations in recent years, and some of the temporary relaxations from the COVID period have become permanent. When U.S. CMS starts attaching a concrete price ($51 + $26) to "2 days of digital patient data," that sets an international reference point.
What Taiwan orthopedics can do right now:
- Build the data infrastructure first — start systematically collecting post-surgical PROM and exercise-adherence data. Not for billing, but for clinical quality and as leverage for future negotiations.
- Track the National Health Insurance Administration's telecare reimbursement pilots — any pilot program touching MSK remote monitoring is a chance to test whether an RTM-style model could work here.
- Learn from the U.S.'s missteps — it took CMS four years to bring the RTM threshold down from 16 days to 2, because the original design was too unrealistic. Taiwan can avoid repeating that mistake when it designs its own digital-health reimbursement.
Closing
Remote monitoring is no longer a "nice to have" add-on. In the U.S., it's now a revenue line with a defined billing code, a defined amount, and a defined threshold. Bringing that threshold down from 16 days to 2 is CMS signaling that its old design was too strict, and that it's willing to adjust pragmatically.
For orthopedic colleagues in Taiwan, even if you won't directly benefit from RTM reimbursement in the near term, the direction of this trend is clear: the value of post-surgical care is being quantified, and that quantification runs on digitized patient data.
The best time to start collecting data is while everyone else still thinks it doesn't matter.
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