Sample Billing Report
What your billing team
actually receives.
Below is a representative end-of-cycle billing PDF for a single patient. Pace generates one of these per active patient, every 30 days. Real reports include the patient’s actual day-by-day data; this sample shows the structure and format your biller and any auditor would see.
Remote Therapeutic Monitoring · Billing Documentation
Report #PACE-202605-0048
Generated 2026-05-30 09:14 ET
Page 1 of 1
Rendering provider
Sarah J. Hartman, MD
Adult Psychiatry · Solo Practice
NPI 1043217856
112 W 9th Street, Suite 402
New York, NY 10011
Monitoring cycle
May 1 – May 30, 2026 (30 days)
Cycle #4 of patient episode
Day-of-data definition: one or more patient-initiated structured responses on a calendar day in the patient’s local timezone
Patient
Name
Margaret L. Chen
Date of birth
1953-08-19 (age 72)
Internal ID
2c4e8f0a-7b15-4d92
Primary ICD-10
F32.1
Major depressive disorder, recurrent, moderate
State of residence
New York
RTM consent signed
2026-02-08 (v2026-01-15)
Days with qualifying patient-generated data
22 of 30
Filled cells indicate days the patient submitted at least one structured response (PHQ-9, GAD-7, C-SSRS, or daily check-in).
Clinician review log
| Date | Start | End | Duration |
|---|---|---|---|
| 2026-05-05 | 10:14 | 10:33 | 19 min |
| 2026-05-12 | 14:02 | 14:18 | 16 min |
| 2026-05-19 | 09:47 | 10:09 | 22 min |
| 2026-05-28 | 16:11 | 16:21 | 10 min |
| Total documented review | 67 min | ||
Recommended CPT codes for this cycle
| 98978 | CBT device supply, 16+ days 22 qualifying days documented in the cycle window above. | ~$55 |
| 98980 | Treatment management, first 20 min Minutes 0–20 of the 67-min total review. | ~$54 |
| 98981 | Treatment management, additional 20 min Minutes 20–40 of the 67-min total. (Minutes 40–67 do not constitute a full additional 20-min increment.) | ~$41 |
| Estimated total reimbursement for this cycle | ~$150 | |
Estimates use CMS 2026 national averages. Your MAC may price 98978 differently by ±10%. Suggested codes are based on documented evidence; final coding decisions remain the responsibility of the rendering provider and billing team.
Episode-to-date (since Feb 2026)
4
Cycles billed
82
Days of data
253 min
Review time
~$594
Estimated total
Clinician attestation
I attest that the patient-generated data and clinician review time documented above accurately reflect the Remote Therapeutic Monitoring services I rendered to the named patient during the cycle window specified. I have personally reviewed the patient’s submitted data and the suggested CPT codes are appropriate to the services delivered.
Sarah J. Hartman, MD · NPI 1043217856
Date
Pace · A product of NeuroMotive, LLC · pace.neuromotive.health
Generated 2026-05-30 09:14 ET
All names, dates, and figures above are illustrative. Real reports use the actual patient’s data and your practice information.
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