RTM for Cognitive Behavioral Monitoring: A Billing Guide
Remote Therapeutic Monitoring (RTM) for cognitive behavioral monitoring uses CPT/HCPCS code 98978 to bill the device/data-transmission side of monitoring a patient's cognitive-behavioral therapy plan between visits, paired with 98980/98981 (or, starting in 2026, 98979) to bill the clinical time spent reviewing that data and communicating with the patient.
This page provides general educational information about CPT and RTM billing codes. It is not coding advice, a guarantee of reimbursement, or a substitute for your own compliance review. Payer coverage and documentation requirements vary by plan and can change — verify current requirements with CMS, your Medicare Administrative Contractor, and each payer before billing.
Why "Cognitive Behavioral" RTM Is Its Own Category
RTM's device-supply codes are split by the body system or therapy type being monitored: respiratory, musculoskeletal, and cognitive behavioral therapy (CBT). A concussion, headache, or post-injury mental-health practice tracking symptom scores, mood screens, or cognitive complaints between visits falls under the cognitive behavioral category — not musculoskeletal, even when the underlying diagnosis is a physical injury like concussion. This distinction matters because the CPT code family assigns a specific device-supply code to each monitoring category, and billing the wrong one is a common source of denials.
98978 — Device Supply for Cognitive Behavioral Monitoring
What it covers: the supply of a device or platform that collects and transmits patient-reported cognitive-behavioral data — symptom checklists, mood/anxiety screens, sleep questionnaires, or similar structured self-report — over a defined monitoring period.
2026 update: effective January 1, 2026, the descriptor for 98978 was revised to specify 16–30 days of data within a 30-day period (previously stated simply as "16 days or more"). A new shorter-duration companion code, 98986, was introduced for the same category covering 2–15 days of data in a 30-day period. Only one of these two device-supply codes — not both — may be billed for the same patient in the same 30-day period. Whether 98986 carries the same "sometimes therapy" designation as its 2026 sibling codes was less consistently corroborated in available sources and should be confirmed against the current CPT code book before relying on it.
Who bills it: the supervising physician or other qualified health care professional (QHP) whose practice supplies the monitoring device/platform and receives the transmitted data — not billed by the patient or a third-party technology vendor independently.
Documentation requirements: the medical record should show that a device or digital platform was used to collect data tied to a cognitive-behavioral therapy plan, the specific condition being monitored, and evidence that at least the minimum number of days of data required by the code selected (2 or 16, depending on which variant is billed) was actually transmitted within the 30-day period.
Common denial reasons: billing 98978 without the minimum data-days threshold actually met and documented; billing both the standard and short-duration device codes for the same period; missing linkage in the note between the device data and an active treatment/monitoring plan; using 98978 for musculoskeletal-only monitoring (98977/98985 is the correct code there).
98980 / 98981 — RTM Treatment Management (20+ Minutes)
What it covers: clinical staff, physician, or QHP time spent each calendar month reviewing the transmitted monitoring data, adjusting the care plan, and communicating with the patient. 98980 covers the first 20 minutes; 98981 is an add-on for each additional 20 minutes.
Requirement: at least one real-time interactive communication with the patient or caregiver during the month — a live phone or video check-in, not solely a chart review. CMS guidance clarifies audio-only calls satisfy this requirement; some secondary sources describe broader asynchronous flexibility, but that point is less firmly corroborated and should be checked against the current final-rule text before being treated as settled.
Documentation: total monthly time (start/stop or total minutes), a description of what was reviewed, and the date/mode of the real-time communication.
98979 (New for 2026) — Short-Duration Treatment Management
Effective January 1, 2026, CPT added 98979 to cover the first 10–19 minutes of qualified monthly time — a lower threshold than the 20-minute minimum required by 98980. It still requires at least one real-time interactive communication with the patient or caregiver during the month. A practice bills either 98979 or 98980 (plus 98981 as applicable) for a given patient in a given month — not both. This code exists specifically to remove the "all-or-nothing" billing cliff for patients whose monthly engagement falls short of 20 minutes but still reflects real clinical review and outreach.
Worked Example (No Dollar Amounts)
A sports-medicine practice enrolls a patient recovering from concussion in a monitoring plan using a symptom-tracking and mood-screening platform between follow-up visits. Over a 30-day period, the patient submits data on 18 separate days. The practice bills 98978 for that period. During the same calendar month, a clinical staff member spends 22 minutes reviewing the transmitted data, updating the care plan, and completing one live phone call with the patient to discuss results. The practice bills 98980 for the first 20 minutes and 98981 for the additional 2 minutes, provided its unit-rounding approach is consistent with current CPT time-rule conventions and payer policy. If instead the patient had only 12 days of data in the period and clinical staff spent 14 minutes with one live call, the practice would consider 98986 (once its details are confirmed) and 98979 rather than the standard codes.
Documentation Checklist
- Device/platform supplied and linked to a specific cognitive-behavioral monitoring plan
- Number of days of data transmitted within the 30-day period, matched to the code billed
- Total monthly clinical time, with start/stop or total minutes
- Date and mode of at least one real-time interactive communication per month
- Clear condition/diagnosis the monitoring supports (e.g., post-concussion symptoms, anxiety, PTSD screening)
Related and Adjacent Codes
- 98975 — initial RTM set-up and patient education, billed once per episode
- 98980-98981 — RTM treatment management, 20+ minutes
- 98979 — new short-duration RTM treatment management
- 96132 and 96133 — neuropsychological test evaluation, a distinct service from RTM device monitoring
How Kavera Handles This
Kavera is a cognitive behavioral monitoring device by design: brain training for attention and focus, a clinician-gated guided support tool for mild anxiety and depression, and weekly symptom and mood check-ins, all delivered through the platform and all counted toward the 98978 day threshold. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials. Educational, not coding advice. Verify requirements with CMS, your MAC and each payer.