How to Start an RTM Program in Your Pediatric Clinic

What should you check with payers before you start?

Before anything else, confirm RTM coverage with your top payers — for pediatric clinics that usually means state Medicaid and two or three dominant commercial plans. Medicare coverage is nationwide with published rates, but pediatric caseloads rarely run on Medicare, so the payer mix check is the single most important pre-launch task. Ask each payer five questions: are 98975/98977/98980 covered for your discipline, is prior authorization required, what documentation do they expect, what cost sharing lands on the family (deductible, coinsurance, or copay — see below, because you’ll be quoting this at consent), and — the one people forget — does the plan treat RTM as a visit? It shouldn’t; RTM doesn’t consume an authorized visit under Medicare rules. But some commercial and Medicaid plans have applied it against visit limits anyway, and you want to know that before you enroll a caseload rather than after. Rates for your locality live on the CMS fee schedule search; if you need the code-level background first, it’s in RTM CPT codes explained.

How do you choose an RTM platform?

The platform decides whether your thresholds get met, so evaluate it on behavior, not features. The checklist that matters:

• No hardware. Software on the parent’s own phone qualifies as the RTM device — anything that requires shipping equipment adds cost and failure points.
• Logging in seconds, not minutes. In pediatrics the parent is the logger. A text-message link they tap after the session beats an app they have to remember, download, and log into. This single design choice largely determines whether families reach 16 days. The clinician side of the same loop — building the home program inside the session instead of after hours — is covered in the 3-minute HEP workflow.
• Automatic threshold tracking. Qualifying days per 30-day period counted from each patient’s RTM start date, review minutes per calendar month, interactive-communication flags — counted in the background, with mid-period alerts for patients trending short. Note those are two different clocks that drift apart over an episode, which is exactly why hand-tracking fails.
• Audit-ready exports. Timestamped, per-day, per-minute records your biller can attach to a claim, compatible with your EMR workflow.
• Built for children. Exercise content, family communication, and engagement mechanics designed for parents and kids — not adapted from adult ortho.

This checklist is, transparently, what Sulo is built to satisfy for pediatric PT, OT, and SLP clinics.

Where does RTM consent fit into your intake?

Make RTM consent a standard part of intake paperwork, not a separate campaign. The consent conversation is short: what’s being monitored (exercise completion, effort, pain), how the family logs it, how the clinic uses the data between visits, and — the part clinics skip — what the family can expect to owe, covered in the next section. Document consent in the chart, then handle setup and education in the same visit — that session becomes your one-time 98975 claim, billable once the family has logged on 2 days. You can send it on the day of that second transmission or hold it to the end of the 30-day period; both are compliant.

What will the family actually pay?

RTM is a billable medical service, not a free extra — somebody owes a share of every claim, and the family should hear that number from you at consent rather than from a statement in month three. What they owe depends entirely on the payer.

Medicare. Part B pays 80% of the allowed amount; the beneficiary owes the other 20%, after the annual deductible — $283 in 2026. On the recurring pair at national rates that’s about $21 a month ($10.29 on 98977 plus $10.82 on 98980), plus $4.34 the month you bill setup. Because coinsurance is a percentage of the locality-adjusted amount, it tracks geography the same way your payment does: the device-supply code alone runs roughly $8.81 to $14.77 per period depending on where you are. Many beneficiaries carry supplemental coverage that absorbs this; plenty don’t.

Medicaid. For most pediatric caseloads this is the column that matters, and the answer is usually little or nothing. Federal rules prohibit cost sharing for most children under 18 — the exemptions are defined by eligibility group rather than by age alone — and total premiums and cost sharing for a Medicaid household are capped at 5% of family income. Separate CHIP programs may charge something, but a parallel cumulative 5%-of-income cap applies there too. State plans vary; confirm yours.

Commercial plans. The real variable, and the one that generates surprise bills. RTM lands against whatever the contract says — a deductible, coinsurance, or a flat copay per claim — and a family on a high-deductible plan can owe the entire allowed amount until that deductible is met. Ask this question during the same payer check you run in step one.

The operational stake is higher than the dollar figure suggests. In pediatrics you are asking a parent to log data nearly every day; a parent who discovers in month three that their own logging generated a bill will disenroll, and they will tell the front desk exactly why. Saying the number out loud during setup costs you one sentence and is the cheapest retention work in the program.

Which patients should you enroll first?

Your first cohort should be patients who already have an active home program and an engaged caregiver. You’re not adding clinical work — you’re instrumenting work that already exists. Good first enrollees:

• Conditions with multi-week home programs: torticollis, developmental delay, post-op protocols, gross-motor goals.
• Families you already text or call between visits.
• Episodes with at least a month or two of care remaining, so recurring codes have room to recur.

Start with 10–20 patients. It’s enough volume to build the habit and prove the economics without overwhelming the team.

What does the monthly RTM loop look like?

RTM succeeds or fails on two recurring behaviors — family logging and clinician review. The operating rhythm:

1. Families log each session from their phone; qualifying days accumulate toward 98977.
2. Someone reviews weekly. A 5-minute scan per patient per week comfortably clears 20 minutes by month-end. Assistants can do this under general supervision, with the therapist owning program changes — see who can bill RTM for the supervision rules.
3. One live touchpoint per month. A short check-in with the parent satisfies 98980’s interactive-communication requirement and is genuinely useful care. An audio-only phone call counts, video counts, and so does talking it through in person at a visit — as long as that time isn’t also counted toward the billable visit. Texts and portal messages don’t count, because they aren’t synchronous.
4. Mid-month, rescue the at-risk. Anyone below pace on logging days gets a nudge while the period can still be saved.

How do you bill and reconcile at month-end?

Month-end should be a report, not an investigation. For each enrolled patient: did they clear 16 days (bill 98977) or land at 2–15 (bill 98985), did review time clear 20 minutes with a live communication (bill 98980) or land at 10–19 (bill 98979), and is this the first setup claim for this episode of care (add 98975)? Append the right therapy modifier — GP, GO, or GN — and add CQ or CO when a PTA or OTA furnished part of the service, which attaches to the management codes but never to device supply. Keep the per-day and per-minute logs attached to the claim record. One caveat on the partial-period codes: 98985 and 98979 are new for 2026, and payer adoption varies — confirm with your MAC and your commercial plans before you rely on them. Then, quarterly, look at the program itself: enrollment rate, threshold hit rate, and denial patterns will tell you exactly which of the common RTM billing mistakes to fix.

What makes launches fail?

Almost never the clinical side. The recurring killers:

• Manual tracking. A spreadsheet works for the pilot month, then quietly falls behind and takes the program’s compliance with it.
• Hard-to-log tools. Every extra tap costs qualifying days, and in pediatrics the margin is thin.
• No owner. “Everyone reviews their own patients” becomes “no one reviewed this month.”
• Enrolling everyone at once. Scale after the loop works, not before.

Start small, automate the counting, and RTM becomes a durable revenue layer on care you were already delivering. For the complete picture — including a live estimator for your clinic’s volume — read the full RTM guide, or talk to us about running it on Sulo.