Reimbursement
How the math
works.
The RTM codes Pace generates, what each one pays, and why a typical engaged patient is worth about $150 per month to your practice. The math below uses Medicare national-average rates; commercial payers reimburse in a comparable band.
Per-Patient Math
Why a single patient is worth ~$150/month.
The codes look complicated because they overlap in time but pay for different things — like a restaurant bill that separates the cover, the food, and the service.
- 98975 pays for getting a new patient set up on Pace. Once per episode.
- 98978 (or 98986) pays for Pace itself — the platform collecting daily data. Once per 30 days.
- 98980, 98981, and 98979 pay for your review time. They stack with the device-supply codes; they bill the same 30-day window.
Both pieces are needed because Medicare separates the “tool that monitored the patient” from “the clinician who looked at the data.”
Sample 30-day cycle, engaged patient
These codes stack — you bill them together for the same patient in the same month. No single code is the whole number; they add up:
| CPT | Pays for | Amount |
|---|---|---|
| 98975 | RTM setup (one-time per episode) | ~$22 |
| 98978 | Pace collecting ≥16 days of patient data | + ~$55 |
| 98980 | Your first 20 min of review | + ~$54 |
| 98981 | Your next 20 min of review | + ~$41 |
| = Total, first cycle (includes setup) | ~$172 | |
| = Each subsequent cycle (no setup) | ~$150 | |
Rates are CMS 2026 national averages. MAC-specific values vary by ±10%. The $145-170 range is real — it shifts based on how much review time you document. 65 min of review = 98980 + 98981 × 2 = $136 of review-time billing. 25 min = 98980 only = $54.
You attest your review time
CMS accepts clinician self-attestation for time-based RTM codes. At the end of each cycle, you document your total review minutes — patient detail page, PDF reviews, phone consults, messages, care-plan edits — and sign. Pace keeps a silent activity log alongside the attestation as audit support.
At a steady-state panel of 30 active patients, that’s roughly $4,500/month of RTM reimbursement for work you’re already doing — billed alongside whatever you currently submit, with no additional appointment scheduling required.
Run the Numbers
What this looks like for your panel.
Plug in your panel size, region, and engagement assumptions. The calculator picks the Pace tier that fits and shows your monthly net.
Calculator
Estimate your panel.
Defaults reflect what we typically see in practice. Adjust each one to match your panel and region.
Patients with a behavioral-health indication that fits RTM — Medicare, Medicare Advantage, or commercial.
Patients who say yes when offered RTM. High-trust panels run higher.
Share of enrolled patients who clear 16 days of data each cycle (98978 at $55). The rest still bill 98986 at $40 — both included below.
You self-attest your total review time per cycle — phone consults, PDF reviews, messages, care-plan edits, all of it. CMS accepts clinician self-attestation for these time-based RTM codes, billed in 20-minute blocks.
National average — typical metro markets
Active billing patients
80
64 full-cycle · 16 short-cycle
Your monthly net
+$13,139
Annual
+$157,668
80 × $136 review + 64 × $55 (98978) + 16 × $40 (98986) = $15,040 gross · × 1.00 GPCI × 0.98 sequestration − $1,600 tier = $13,139/mo
Estimates use 2026 CMS national-average fee-schedule values: 98978 ($55, 16+ days), 98986 ($40, 2–15 days), 98980 ($54, first 20 min), 98981 ($41 per additional 20 min). Applies 2% Medicare sequestration and simplified three-tier GPCI. Commercial plans reimburse RTM under their own policies — BCBS/Anthem, UnitedHealthcare, and Aetna land in a comparable band (~$50–64 for 98978), so these Medicare-based figures are a conservative baseline for a mixed panel. Actual reimbursement varies by your MAC, plan, modifier mix, and payer mix.
New for 2026
A new code — 98986 — for the patients who skip a day.
For a long time, the practical objection to RTM was the 16-day cliff: if your patient didn’t hit 16 days of qualifying data in a 30-day window, you got nothing. Engagement was a survival question.
CMS’s Calendar Year 2026 Physician Fee Schedule Final Rule introduced CPT 98986 — the short-window equivalent of 98978. It pays roughly $40 when the patient hits 2-15 days of data. The 2-day floor means almost any actively-engaged patient generates billable revenue, even if they have a bad month.
Pace’s billing engine checks the day count automatically at cycle close and selects the right code. You don’t track this. Your biller doesn’t track this. Pace handles it.
And engagement is something we actively design for. Beyond the check-in, Pace resurfaces meaningful photos, surfaces a letter the patient wrote to themselves, and adds small rewards they grow — plants and animals that develop over days. It’s a mix we keep expanding to keep patients using the app between visits, and steadier engagement is what moves a patient toward a billable day count. The patient sees rewards and reminders, never a billing mechanic.
Day count → code mapping
- ≥16 days of data98978 (~$50-55)
- 2-15 days of data98986 (~$40)
- 0-1 days of dataNot billable (device supply)
This is only the device-supply piece. Your review-time codes (98980/98981/98979) stack on top — which is why a typical engaged patient totals ~$150/cycle, not just the ~$55 above.
Audit Defensibility
Surviving the RAC / OIG / MAC audit.
OIG’s August 2025 RPM audit report found that 43% of RPM enrollees did not receive all three components (setup, device supply, treatment management). That kind of pattern triggers MAC post-payment audits. RTM is widely expected to follow.
Pace’s billing PDF was designed against the audit pattern, not the marketing pattern. Every PDF includes:
- Rendering provider name, credential, NPI, and address
- Patient demographics, internal ID, and ICD-10 substantiating the cognitive/behavioral indication
- Explicit definition of what counts as a “day of data” (Pace defines it; CMS doesn’t)
- The cycle window and the day-by-day grid showing every qualifying calendar day
- Clinician review-time log with timestamps and duration
- The recommended CPT codes with a written rationale linking each to the documented evidence
- An attestation line for your signature
Your biller hands this to the MAC if the claim is challenged. The PDF answers every question an auditor would ask.
Common reimbursement questions
See the full breakdown for your patients.
We’ll do the per-patient revenue math against your current patient count during a 20-minute call.