Revenue Model & Split Calculator

RTM Revenue Calculator

Model gross reimbursement, apply your cost waterfall, and see exactly what the RTM team earns per patient — powered by 2025 Ohio Medicaid rates.

Monthly gross

Jonathan / month

Annualized

Per patient kept

Program Settings

Total patients enrolled 500

50500

Monthly compliance rate 80%

40%100%

% of patients hitting the 16-day check-in threshold — required for 98977, 98980, 98981

RTM team size 2

110

Reimbursement Rates

Ohio Medicaid 2025

Defaults based on 2025 Medicare PFS + ~5% Ohio Medicaid HB33 uplift. Adjust for managed care contracts.

98975 — Initial setup (one-time)

98977 — MSK device supply (monthly)

98980 — Treatment mgmt, first 20 min (monthly)

98981 — Treatment mgmt, add'l 20 min (monthly)

98981 usage

Avg 98981 units per patient / month 1

0 (skip)3 units

Cost Waterfall

Per compliant patient

Clinic overhead cut 40%

0%70%

Dr. Jackson — flat fee / patient $25

$0$60

BMIQ platform fee / patient $10

$0$30

Gross / month

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Compliant patients

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— of enrolled

Per patient gross

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recurring monthly

Month 1 bonus

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98975 setup codes

Jonathan (RTM Team) · Net Remainder After All Deductions

Per patient / month

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—% of gross

Total / month

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Annualized

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12-month run rate

Per team member / yr

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÷ 2 people

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Gross reimbursement Jonathan total Deductions

Based on current compliance rate and cost structure settings above.

RTM CPT Code Reference

Ohio Medicaid · 2025 rates

98975

▶ One-time per episode of care

$20

Ohio Medicaid

Initial setup & patient education
First-time setup of RTM equipment or software and education of the patient or caregiver. Billed once per episode of care when monitoring is initiated.
Billed once per episode of care — not repeating monthly
Requires ≥16 days of data within the first 30-day period
Must document patient/caregiver education on equipment use
Cannot be billed if patient already owns the monitoring device
Written patient consent required before billing begins

98977

▶ Monthly · every 30 days

$47

Ohio Medicaid

MSK device supply — musculoskeletal monitoring
Reimburses for supply of a device/app that monitors musculoskeletal status via scheduled daily recordings and programmed alerts. Covers medication adherence, pain, ROM, and functional status.
Billed once every 30 days — one practitioner only per episode
Patient must have ≥16 unique days of data within the 30-day period
Cannot be billed alongside 98976 (respiratory) or 98978 (CBT) same month
Self-reported patient data via app qualifies as "device" data per CMS

98980

▶ Monthly · first 20-min block

$54

Ohio Medicaid

Treatment management — first 20 minutes
First 20 minutes of clinical time reviewing RTM data, managing the patient's program, and communicating with the patient per calendar month. Must include at least one interactive communication.
Requires full 20 minutes documented — 19 minutes does not qualify
Must include at least one real-time synchronous call (phone or video)
Secure messaging alone does not satisfy the communication requirement
Time includes data review, care plan adjustments, documentation, and patient interaction

98981

▶ Monthly · each add'l 20-min block

$43

Ohio Medicaid

Treatment management — each additional 20 minutes
Each complete additional 20-minute block beyond 98980. Multiple units may be billed in a single month. The live call requirement from 98980 is shared — no separate call needed per 98981 unit.
Cannot be billed unless 98980 has been billed same month
Requires a full additional 20 minutes — partial blocks are not billable
Multiple units allowed (e.g., 60 min total = 98980 × 1 + 98981 × 2)
Document each unit with timestamps for start/end of monitoring activities

Monthly compliance checklist — 98977 + 98980 + 98981

Requirement	98977	98980	98981
16+ days of patient-reported data	✓ Required	Not required	Not required
Real-time synchronous call (phone/video)	Not required	✓ Required	Shared with 98980
Minimum time threshold documented	Not time-based	✓ Full 20 min	✓ Full 20 min / unit
Single billing provider per 30-day period	✓ Yes	✓ Yes	✓ Yes
Written patient consent on file	✓ Required	✓ Required	✓ Required
Cannot be billed alongside RPM same month	✕ Restriction	✕ Restriction	✕ Restriction

Call Operations · Team Capacity

RTM Call Capacity Calculator

Model how many calls your team needs each day, week, and month to bill 98980 + 98981 across your patient panel. Adjust any variable and see capacity constraints instantly.

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Calls per agent / day

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Team utilization

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Max patients supportable

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Billable mins / agent / day

Program settings

Drag sliders to model

Total patients enrolled500

50500

RTM compliance rate80%

40%100%

% of patients hitting the 16-day check-in threshold — required to bill 98977, 98980, 98981

RTM call agents2

Billing target

Target mins per patient / month40 min

20 min60 min

20 min = 98980 only · 40 min = 98980 + one unit of 98981 · 60 min = 98980 + two 98981 units

Call structure

Time per interaction

Avg live call duration12 min

5 min30 min

Live call time only. Data review + documentation also counts toward 98980/98981 — adjust wrap-up accordingly.

Wrap-up / documentation per call5 min

1 min20 min

Workday

Working hours per agent per day8.0 hrs

5 hrs10 hrs

Admin / overhead buffer20%

0%50%

Meetings, training, non-RTM tasks. Subtracted from available call time each day.

Working days per month21 days

1823

Key billing requirements

98980First 20 min of RTM treatment management per month. Requires at least one real-time synchronous call (phone or video). Must hit the full 20 — 19 minutes does not qualify.

98981Each additional 20-min block beyond 98980, same month. 98980 must be billed first. The call requirement is shared — additional time can be data review and documentation.

NoteThe 40-minute total does not all need to be live call time. A 10-min call + 30 min of documented review satisfies both codes — this is the key to making the math work at scale.

Per-agent workload

2 agents

Daily workday breakdown — per agent

Agents required at each patient panel size, given current call structure and compliance rate.